Provider Demographics
NPI:1669005187
Name:MCDONALD, LAURA KAY
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KAY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12959 JUPITER RD STE 140
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-3200
Mailing Address - Country:US
Mailing Address - Phone:214-221-0132
Mailing Address - Fax:214-221-0242
Practice Address - Street 1:12959 JUPITER RD STE 140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-3200
Practice Address - Country:US
Practice Address - Phone:214-221-0132
Practice Address - Fax:214-221-0242
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional