Provider Demographics
NPI:1194917146
Name:CROMWELL, LAURA ANN (LCPC, LMFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:CROMWELL
Suffix:
Gender:F
Credentials:LCPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3556 N LENA AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-4727
Mailing Address - Country:US
Mailing Address - Phone:208-376-5683
Mailing Address - Fax:
Practice Address - Street 1:815 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5538
Practice Address - Country:US
Practice Address - Phone:208-376-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC - 3007101YP2500X
IDLMFT - 3072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist