Individual
LAURA GILLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3409 S 200 W, KOKOMO, IN 46902-9613
(260) 563-8453
Mailing address
3563 S STATE ROAD 13, WABASH, IN 46992-9162
(260) 563-8453
(260) 569-0335
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001976
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201097990
—
IN
Enumeration date
02/16/2007
Last updated
01/13/2015
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