Provider Demographics
NPI:1457158610
Name:FRAZIER, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15533 VALERIO ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3330
Mailing Address - Country:US
Mailing Address - Phone:818-486-3203
Mailing Address - Fax:
Practice Address - Street 1:23901 CALABASAS RD STE 1069
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1583
Practice Address - Country:US
Practice Address - Phone:626-720-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19-86427106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician