Provider Demographics
NPI:1710276159
Name:MORELAND, LAURA M (LSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:MORELAND
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78505-0489
Mailing Address - Country:US
Mailing Address - Phone:956-631-9171
Mailing Address - Fax:956-631-7566
Practice Address - Street 1:2422 E TYLER AVE STE C
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7471
Practice Address - Country:US
Practice Address - Phone:956-423-9171
Practice Address - Fax:956-423-7457
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26109104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2204653Medicaid