Provider Demographics
NPI:1215250329
Name:DODGE, LAURA (LMFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DODGE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:12321 HIGH COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-6838
Mailing Address - Country:US
Mailing Address - Phone:661-549-9911
Mailing Address - Fax:
Practice Address - Street 1:1412 17TH ST
Practice Address - Street 2:258
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5211
Practice Address - Country:US
Practice Address - Phone:661-747-5498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53107106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist