Provider Demographics
NPI:1699136663
Name:SEITEL, LAURA (PHD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SEITEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 HAMILTON AVENUE
Mailing Address - Street 2:SUITE 333
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301
Mailing Address - Country:US
Mailing Address - Phone:650-325-4558
Mailing Address - Fax:650-325-5125
Practice Address - Street 1:550 HAMILTON AVENUE
Practice Address - Street 2:SUITE 333
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301
Practice Address - Country:US
Practice Address - Phone:650-325-4558
Practice Address - Fax:650-325-5125
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN8406403103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical