Provider Demographics
NPI:1801915582
Name:SMITH, LAURA LOUISE (LPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LOUISE
Last Name:SMITH
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 1:119 NORTH ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-5238
Mailing Address - Country:US
Mailing Address - Phone:936-560-6855
Mailing Address - Fax:936-564-5232
Practice Address - Street 1:119 NORTH ST
Practice Address - Street 2:SUITE I
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-5238
Practice Address - Country:US
Practice Address - Phone:936-560-6855
Practice Address - Fax:936-564-5232
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13439101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional