Organization
ED D LAURITSEN PHD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ED D LAURITSEN PHD (PRESIDENT)
(928) 367-9995
Entity
Organization
Contact information
Practice address
218 W WHITE MOUNTAIN BLVD, SUITE D, LAKESIDE, AZ 85929
(928) 367-9995
(928) 367-9988
Mailing address
218 W WHITE MOUNTAIN BLVD, SUITE D, LAKESIDE, AZ 85929
(928) 367-9995
(928) 367-9988
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1256
AZ
Other
Enumeration date
05/19/2009
Last updated
05/19/2009
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