Provider Demographics
NPI:1821156803
Name:JUDKINS, LAURA RENEE (LMSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RENEE
Last Name:JUDKINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 93RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4513
Mailing Address - Country:US
Mailing Address - Phone:806-392-4730
Mailing Address - Fax:
Practice Address - Street 1:5505 93RD ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-4513
Practice Address - Country:US
Practice Address - Phone:806-392-4730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41962171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator