Provider Demographics
NPI:1407245434
Name:COUTO, LAURA (LCDC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:COUTO
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 K AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5306
Mailing Address - Country:US
Mailing Address - Phone:972-423-8727
Mailing Address - Fax:
Practice Address - Street 1:2600 K AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5306
Practice Address - Country:US
Practice Address - Phone:972-423-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12379101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)