Provider Demographics
NPI:1467871327
Name:COETZEE, LAURA 'TESS' (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:'TESS'
Last Name:COETZEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TESS
Other - Middle Name:
Other - Last Name:COETZEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:551 SEMINOLE LANE
Mailing Address - Street 2:
Mailing Address - City:SOPCHOPPY
Mailing Address - State:FL
Mailing Address - Zip Code:32358
Mailing Address - Country:US
Mailing Address - Phone:850-524-3113
Mailing Address - Fax:
Practice Address - Street 1:551 SEMINOLE LANE
Practice Address - Street 2:
Practice Address - City:SOPCHOPPY
Practice Address - State:FL
Practice Address - Zip Code:32358
Practice Address - Country:US
Practice Address - Phone:850-524-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW11797104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker