Provider Demographics
NPI:1851479976
Name:VENABLE, LAURA (MFT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VENABLE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2099 N COLLINS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2698
Mailing Address - Country:US
Mailing Address - Phone:972-437-4698
Mailing Address - Fax:972-671-2087
Practice Address - Street 1:11344 COLOMA RD
Practice Address - Street 2:SUITE 350
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4457
Practice Address - Country:US
Practice Address - Phone:916-552-6122
Practice Address - Fax:916-852-5838
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37822106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist