Provider Demographics
NPI:1669663118
Name:LAURENCE, CURTIS GLEN (LCSW)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:GLEN
Last Name:LAURENCE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 SPICEWOOD SPRINGS RD 701
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8567
Mailing Address - Country:US
Mailing Address - Phone:512-323-6994
Mailing Address - Fax:
Practice Address - Street 1:1106 CLAYTON LN
Practice Address - Street 2:STE. 445E
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1066
Practice Address - Country:US
Practice Address - Phone:512-323-6994
Practice Address - Fax:512-323-9490
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX359241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical