Provider Demographics
NPI:1962377671
Name:LAURIE, ELIZABETH A (LEP, ABSNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:LAURIE
Suffix:
Gender:F
Credentials:LEP, ABSNP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:LAURIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LEP, ABSNP
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:SUMMERLAND
Mailing Address - State:CA
Mailing Address - Zip Code:93067-0826
Mailing Address - Country:US
Mailing Address - Phone:805-259-6342
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 826
Practice Address - Street 2:
Practice Address - City:SUMMERLAND
Practice Address - State:CA
Practice Address - Zip Code:93067-0826
Practice Address - Country:US
Practice Address - Phone:805-259-6342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP2764103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool