Provider Demographics
NPI:1831117225
Name:PHILLIPS, LAURA VIRGINIA (LPC-S)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:VIRGINIA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7807 BRAESDALE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-1303
Mailing Address - Country:US
Mailing Address - Phone:713-480-3098
Mailing Address - Fax:281-313-5289
Practice Address - Street 1:7807 BRAESDALE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-1303
Practice Address - Country:US
Practice Address - Phone:713-480-3098
Practice Address - Fax:713-583-8119
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPMC171101YP2500X
TX19240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1707028-02Medicaid