Provider Demographics
NPI:1043649098
Name:MCWHORTER, LAURA
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:MCWHORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RANCH HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-4346
Mailing Address - Country:US
Mailing Address - Phone:210-701-0525
Mailing Address - Fax:
Practice Address - Street 1:122 W LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-4322
Practice Address - Country:US
Practice Address - Phone:210-701-0525
Practice Address - Fax:210-960-5070
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-09
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-13-14826103K00000X
TX39197103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist