Provider Demographics
NPI:1124555156
Name:CONDON, LAURA J (LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:CONDON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:CONDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:12500 NW MILITARY HWY # 250
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1897
Mailing Address - Country:US
Mailing Address - Phone:210-302-6920
Mailing Address - Fax:210-302-6952
Practice Address - Street 1:12500 NW MILITARY HWY # 250
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1897
Practice Address - Country:US
Practice Address - Phone:210-302-6920
Practice Address - Fax:210-302-6952
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX329768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085422602Medicaid