Provider Demographics
NPI:1053709253
Name:LAURA ESPINOSA PLLC
Entity type:Organization
Organization Name:LAURA ESPINOSA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:248-925-2250
Mailing Address - Street 1:2730 HUNTERS BLF
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1825
Mailing Address - Country:US
Mailing Address - Phone:248-925-2250
Mailing Address - Fax:
Practice Address - Street 1:39520 WOODWARD AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5054
Practice Address - Country:US
Practice Address - Phone:248-925-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015541261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)