1073409942 NPI number — LAURA LEE GAYMAN

Table of content: LAURA LEE GAYMAN (NPI 1073409942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073409942 NPI number — LAURA LEE GAYMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAYMAN
Provider First Name:
LAURA
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
LAURA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073409942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BEHAVIORAL HEALTH SPECIALIST
Provider Second Line Business Mailing Address:
910 EASY STREET
Provider Business Mailing Address City Name:
BROOKINGS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-510-6455
Provider Business Mailing Address Fax Number:
707-465-4272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DHHS COUNTY OF DEL NORTE (BHD)
Provider Second Line Business Practice Location Address:
455 K ST
Provider Business Practice Location Address City Name:
CRESCENT CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-464-7224
Provider Business Practice Location Address Fax Number:
707-465-4272
Provider Enumeration Date:
06/16/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 372600000X , with the licence number:  1073409942 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)