1427211846 NPI number — MS. LAURIE ANNE TRACHTENBROIT LPC

Table of content: MS. LAURIE ANNE TRACHTENBROIT LPC (NPI 1427211846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427211846 NPI number — MS. LAURIE ANNE TRACHTENBROIT LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRACHTENBROIT
Provider First Name:
LAURIE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KELLOGG
Provider Other First Name:
LAURIE
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427211846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
OFFICE TOWER 550 PEACHTREE STREET NE SUITE 1577
Provider Second Line Business Mailing Address:
C/O INSIGHT PSYCHOTHERAPY EMORY CRAWFORD LONG MEDICAL
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-685-0226
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OFFICE TOWER 550 PEACHTREE STREET NE SUITE 1577
Provider Second Line Business Practice Location Address:
C/O INSIGHT PSYCHOTHERAPY EMORY CRAWFORD LONG MEDICAL
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-685-0226
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2008

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: 101Y00000X , with the licence number:  LPC003860 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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