Provider Demographics
NPI:1144605882
Name:FLANDERS, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FLANDERS
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 1:1656 GLENHILL LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2729
Mailing Address - Country:US
Mailing Address - Phone:469-396-3074
Mailing Address - Fax:
Practice Address - Street 1:103 S WOODROW LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-6308
Practice Address - Country:US
Practice Address - Phone:940-765-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72393101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor