Provider Demographics
NPI:1336428945
Name:CUNNINGHAM, LAURA LYNN (LPC-INTERN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LYNN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 61ST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5305
Mailing Address - Country:US
Mailing Address - Phone:806-786-0918
Mailing Address - Fax:
Practice Address - Street 1:8008 SLIDE RD
Practice Address - Street 2:SUITE #24
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2841
Practice Address - Country:US
Practice Address - Phone:806-786-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YM0800X, 101YP1600X, 106H00000X
TX67597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist