Provider Demographics
NPI:1316971500
Name:LAUER, JOLYNN JEAN (MFT)
Entity type:Individual
Prefix:MS
First Name:JOLYNN
Middle Name:JEAN
Last Name:LAUER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 B ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5273
Mailing Address - Country:US
Mailing Address - Phone:707-525-8710
Mailing Address - Fax:
Practice Address - Street 1:812 SPRING ST
Practice Address - Street 2:A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3904
Practice Address - Country:US
Practice Address - Phone:707-544-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist