Provider Demographics
NPI:1306234364
Name:MATTIASEN, LAURA JEAN (LMHC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:MATTIASEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:MATTIASEN-CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:217 GREGORY RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-5031
Mailing Address - Country:US
Mailing Address - Phone:561-633-5742
Mailing Address - Fax:
Practice Address - Street 1:217 GREGORY RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-5031
Practice Address - Country:US
Practice Address - Phone:561-633-5742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8762101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health