Individual ProviderLaurel KlotzMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address5575 Lake Park Way, Ste. 114, La Mesa, CA 91942-1664(619) 644-7802PECOS EnrollmentBased on the most recent information from CMS, provider Laurel Klotz does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1073998795Provider TypeIndividualFull NameKlotz, LaurelGenderFemaleSole ProprietorYesEnumeration Date7/23/2015Last Updated7/23/2015Contact InformationPractice LocationPractice Address5575 Lake Park Way, Ste. 114, La Mesa, CA 91942-1664Phone(619) 644-7802FaxUnlisted FaxMailing LocationMailing Address5575 Lake Park Way, Ste. 114, La Mesa, CA 91942Phone(619) 644-7802FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicense31740California