Provider Demographics
NPI:1891408373
Name:TAGUE, LAURA REYNOLDS (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:REYNOLDS
Last Name:TAGUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11416 W ZOE LOOP DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-5436
Mailing Address - Country:US
Mailing Address - Phone:661-808-6659
Mailing Address - Fax:
Practice Address - Street 1:11416 W ZOE LOOP DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-5436
Practice Address - Country:US
Practice Address - Phone:661-808-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical