Provider Demographics
NPI:1346558384
Name:ATTERSTROM, LAURA LEIGH (MA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEIGH
Last Name:ATTERSTROM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 SAN JACINTO PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3250
Mailing Address - Country:US
Mailing Address - Phone:214-868-6916
Mailing Address - Fax:
Practice Address - Street 1:7600 SAN JACINTO PL
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3250
Practice Address - Country:US
Practice Address - Phone:214-868-6916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10205101YP2500X
TX2650106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional