Provider Demographics
NPI:1467886895
Name:WAHLSTROM, LAURA CAIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CAIN
Last Name:WAHLSTROM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CAIN
Other - Last Name:HERSCHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2504 RAE DELL AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4735
Mailing Address - Country:US
Mailing Address - Phone:512-660-1853
Mailing Address - Fax:855-700-9866
Practice Address - Street 1:300 BEARDSLEY LN BLDG E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-521-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist