| Doctor Name: | DR. LAURA JEAN EXTEJT |
| NPI Number: | 1588998595 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | E 0004386 |
| Business Practice Address: | 3454 Oak Alley Ct Toledo, OH - 436061306 |
| Business Phone Number: | 4195342468 |
| Business Fax Number: | 4195342397 |
| Mailing Address: | 6232 Jackman Rd, TEMPERANCE |
| State: | MI |
| Postal Code: | 481821039 |
| Phone Number: | 4195093015 |
| Fax Number: | 4195342397 |
| NPI Enumeration Date: | 09/23/2009 |
| NPI Last Update Date: | 09/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | E 0004386 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |