Provider Demographics
NPI:1689798563
Name:DEAN, LAWRIN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LAWRIN
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LAWRIN
Other - Middle Name:
Other - Last Name:FULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:301 W ROSEDALE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4857
Mailing Address - Country:US
Mailing Address - Phone:817-338-4471
Mailing Address - Fax:817-338-1811
Practice Address - Street 1:301 W ROSEDALE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4857
Practice Address - Country:US
Practice Address - Phone:817-338-4471
Practice Address - Fax:817-338-1811
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1777930-02Medicaid
TX177792201Medicaid
TX177793001Medicaid