Provider Demographics
NPI:1841573508
Name:ROBERTSON, LAURA (M ED, LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 KINWEST PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3411
Mailing Address - Country:US
Mailing Address - Phone:972-910-8388
Mailing Address - Fax:
Practice Address - Street 1:1075 KINWEST PKWY STE 107
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3411
Practice Address - Country:US
Practice Address - Phone:972-910-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health