Provider Demographics
NPI:1821451691
Name:PACE, LAURA (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:PACE
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 WISTERIA WAY
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4027
Mailing Address - Country:US
Mailing Address - Phone:214-924-2264
Mailing Address - Fax:
Practice Address - Street 1:1840 N GREENVILLE AVE
Practice Address - Street 2:SUITE 156
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-6724
Practice Address - Country:US
Practice Address - Phone:214-924-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64680101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health