Provider Demographics
NPI:1619613627
Name:FORRESTER, LAURA (LPC-S)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:DODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9872 SAN LEA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-3918
Mailing Address - Country:US
Mailing Address - Phone:214-460-8984
Mailing Address - Fax:
Practice Address - Street 1:9872 SAN LEA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-3918
Practice Address - Country:US
Practice Address - Phone:214-460-8984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70591101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor