Provider Demographics
NPI:1568654416
Name:HOUSE, LAURIE J (LPC,LCPC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
Last Name:HOUSE
Suffix:
Gender:F
Credentials:LPC,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 E SOUTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6258
Mailing Address - Country:US
Mailing Address - Phone:817-690-2005
Mailing Address - Fax:817-552-3501
Practice Address - Street 1:630 E SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6258
Practice Address - Country:US
Practice Address - Phone:817-690-2005
Practice Address - Fax:817-552-3501
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20195101YP2500X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional