Provider Demographics
NPI:1114671583
Name:WALTZ, LAUREN KATE (LPC ASSOCIATE)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:KATE
Last Name:WALTZ
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 STILL WATER CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5559
Mailing Address - Country:US
Mailing Address - Phone:817-301-2261
Mailing Address - Fax:
Practice Address - Street 1:2212 STILL WATER CT
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-5559
Practice Address - Country:US
Practice Address - Phone:817-301-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87966OtherLICENSED PROFESSIONAL COUNSELOR ASSOCIATE