Provider Demographics
NPI:1922625540
Name:POULTER, LAURA BETH (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:POULTER
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 DEERFERN LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2574
Mailing Address - Country:US
Mailing Address - Phone:512-693-4669
Mailing Address - Fax:
Practice Address - Street 1:2845 DEERFERN LN
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2574
Practice Address - Country:US
Practice Address - Phone:512-693-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200122301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical