Provider Demographics
NPI:1588129332
Name:CARRILLO, LAURA ANGELICA (LAC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANGELICA
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N GILBERT RD STE 107-605
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2318
Mailing Address - Country:US
Mailing Address - Phone:480-741-8686
Mailing Address - Fax:
Practice Address - Street 1:1515 N GILBERT RD STE 107-605
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2318
Practice Address - Country:US
Practice Address - Phone:480-741-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC19911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health