Provider Demographics
NPI:1972932473
Name:NUTT, LAURA DIANNE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DIANNE
Last Name:NUTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 HERITAGE TRACE PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5375
Mailing Address - Country:US
Mailing Address - Phone:817-484-6523
Mailing Address - Fax:817-447-3299
Practice Address - Street 1:4232 HERITAGE TRACE PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5375
Practice Address - Country:US
Practice Address - Phone:817-484-6523
Practice Address - Fax:817-447-3299
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68753101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional