Provider Demographics
NPI:1275153496
Name:EVANS, LAURA JEAN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 KIRKWOOD RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-1508
Mailing Address - Country:US
Mailing Address - Phone:214-802-3694
Mailing Address - Fax:
Practice Address - Street 1:1300 KIRKWOOD RD UNIT A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-1508
Practice Address - Country:US
Practice Address - Phone:214-802-3694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202678106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist