Provider Demographics
NPI:1992908362
Name:LAING, MARY M (LMFT,LICSW,RN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:M
Last Name:LAING
Suffix:
Gender:F
Credentials:LMFT,LICSW,RN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:KINGSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16817 UPPER 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:MN
Mailing Address - Zip Code:55043-9416
Mailing Address - Country:US
Mailing Address - Phone:651-491-4805
Mailing Address - Fax:651-578-0021
Practice Address - Street 1:6053 HUDSON RD
Practice Address - Street 2:SUITE 192
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1015
Practice Address - Country:US
Practice Address - Phone:651-491-4805
Practice Address - Fax:651-578-0021
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN78051041C0700X
MN739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist