Provider Demographics
NPI:1225280308
Name:MANN, LAURA LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LYNN
Last Name:MANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LYNN
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1250 W MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 550
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4902
Mailing Address - Country:US
Mailing Address - Phone:469-904-3549
Mailing Address - Fax:214-819-2405
Practice Address - Street 1:1250 W MOCKINGBIRD LN
Practice Address - Street 2:SUITE 550
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4902
Practice Address - Country:US
Practice Address - Phone:469-904-3549
Practice Address - Fax:214-819-2405
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35052104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12024626OtherCAQH PROVIDER ID