Provider Demographics
NPI:1740297209
Name:TUSA, LAURA BETH (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:BETH
Last Name:TUSA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:BETH
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1600 PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-2261
Mailing Address - Country:US
Mailing Address - Phone:254-313-4200
Mailing Address - Fax:254-313-4326
Practice Address - Street 1:2201 MACARTHUR DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708
Practice Address - Country:US
Practice Address - Phone:254-313-5300
Practice Address - Fax:254-313-5399
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028422605Medicaid
TX028422604Medicaid
TX028422601Medicaid