Provider Demographics
NPI:1174760144
Name:MORI, LAURA ANN (MFT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:MORI
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 1:630B UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2019
Mailing Address - Country:US
Mailing Address - Phone:650-323-3340
Mailing Address - Fax:650-941-9726
Practice Address - Street 1:630B UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2019
Practice Address - Country:US
Practice Address - Phone:650-323-3340
Practice Address - Fax:650-941-9726
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 31857106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist