Provider Demographics
NPI:1154772408
Name:LAURA S MINDELL PLLC
Entity type:Organization
Organization Name:LAURA S MINDELL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:SHIRA
Authorized Official - Last Name:MINDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC NCC
Authorized Official - Phone:248-325-7476
Mailing Address - Street 1:PO BOX 2042
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-2042
Mailing Address - Country:US
Mailing Address - Phone:248-325-7476
Mailing Address - Fax:248-282-0666
Practice Address - Street 1:32000 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 128
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1565
Practice Address - Country:US
Practice Address - Phone:248-325-7476
Practice Address - Fax:248-282-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013930101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty