Provider Demographics
NPI:1699801365
Name:COLLIGAN, LAURA B (MFT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:B
Last Name:COLLIGAN
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 1:3320 KEMPER ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4905
Mailing Address - Country:US
Mailing Address - Phone:619-758-6226
Mailing Address - Fax:619-758-6255
Practice Address - Street 1:3320 KEMPER ST STE 206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4905
Practice Address - Country:US
Practice Address - Phone:619-758-6226
Practice Address - Fax:619-758-6255
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 22823106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT 22823OtherMARRIAGE, FAMILY THERAPIS