Basic Information
| Provider Information | |||||||||
| NPI: | 1033197025 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR LAURA A BEAUMONT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 609 | ||||||||
| Address2: | |||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604770609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089237400 | ||||||||
| FaxNumber: | 7089237409 | ||||||||
| Practice Location | |||||||||
| Address1: | 11801 SOUTHWEST HIGHWAY | ||||||||
| Address2: | STE 3 SOUTH | ||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089237400 | ||||||||
| FaxNumber: | 7089237409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 01/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | BEAUMONT | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | LINCENSED CLINICAL PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 7089237400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSYD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | IL071005432 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.