Provider Demographics
NPI:1407952161
Name:OUELLETTE, LAURENCE EDWARD (LPC)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:EDWARD
Last Name:OUELLETTE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180542
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78718-0542
Mailing Address - Country:US
Mailing Address - Phone:512-912-6332
Mailing Address - Fax:
Practice Address - Street 1:805 W 10TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2047
Practice Address - Country:US
Practice Address - Phone:512-912-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431585399Medicaid