Provider Demographics
NPI:1548908254
Name:MUNDY, LAURA (LPC, NCC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MUNDY
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 W HAYS ST SUITE # 201
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4048
Mailing Address - Country:US
Mailing Address - Phone:208-953-1489
Mailing Address - Fax:
Practice Address - Street 1:1524 W HAYS STREET SUITE #201
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4048
Practice Address - Country:US
Practice Address - Phone:208-953-1489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional