Provider Demographics
NPI:1780275883
Name:MCINNIS, LAURA MAY (LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MAY
Last Name:MCINNIS
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 1:1908 CHATTANOOGA DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7652
Mailing Address - Country:US
Mailing Address - Phone:214-885-5657
Mailing Address - Fax:
Practice Address - Street 1:4200 S HULEN ST STE 450
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4910
Practice Address - Country:US
Practice Address - Phone:214-885-5657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional