Provider Demographics
NPI:1356497051
Name:MANUPPELLI, LAURA (PHD LMFT LPC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:MANUPPELLI
Suffix:
Gender:F
Credentials:PHD LMFT LPC
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:MANUPPELLI
Other - Last Name:LIFSHUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD LMFT LPC
Mailing Address - Street 1:4901 BROADWAY
Mailing Address - Street 2:SUITE 152
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-824-6884
Mailing Address - Fax:210-826-7882
Practice Address - Street 1:4901 BROADWAY
Practice Address - Street 2:SUITE 152
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-824-6884
Practice Address - Fax:210-826-7882
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 11199101YP2500X
TXLMFT 2749106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist