Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 4467 | CO |
NPI | 1003014721 |
---|---|
Provider Name | Laura L Mcgourty |
First Address | Durango, CO 81303-3409 |
Second Address | Durango, CO 81303-3409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 08/07/2007 |