Provider Demographics
NPI:1003663816
Name:SPEED, LAURIE RENEE
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:RENEE
Last Name:SPEED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8627 CINNAMON CREEK DR BLDG 401
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1482
Mailing Address - Country:US
Mailing Address - Phone:210-549-6663
Mailing Address - Fax:210-610-8291
Practice Address - Street 1:8627 CINNAMON CREEK DR BLDG 401
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1482
Practice Address - Country:US
Practice Address - Phone:210-549-6663
Practice Address - Fax:210-610-8291
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16965101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional