Provider Demographics
NPI:1922389964
Name:TONGCHIAXYOOJ, LAURA (MS, MFT-IT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:TONGCHIAXYOOJ
Suffix:
Gender:F
Credentials:MS, MFT-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:WI
Mailing Address - Zip Code:53015-4535
Mailing Address - Country:US
Mailing Address - Phone:920-323-2281
Mailing Address - Fax:920-683-4908
Practice Address - Street 1:3810 ROSIN CT STE 180
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1656
Practice Address - Country:US
Practice Address - Phone:916-567-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134-228104100000X
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker