Provider Demographics
NPI:1568528602
Name:WARNER, LAURA JAN (MS, LPA, LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JAN
Last Name:WARNER
Suffix:
Gender:F
Credentials:MS, LPA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8719 FOREST HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4026
Mailing Address - Country:US
Mailing Address - Phone:214-537-9718
Mailing Address - Fax:214-660-0755
Practice Address - Street 1:8719 FOREST HILLS BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-4026
Practice Address - Country:US
Practice Address - Phone:214-537-9718
Practice Address - Fax:214-660-0755
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12364101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLP0022770Medicaid