Provider Demographics
NPI:1881714673
Name:JEFFRIES, LAURA L (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:L
Last Name:JEFFRIES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8830 LONG POINT RD
Mailing Address - Street 2:SUITE 802
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-3040
Mailing Address - Country:US
Mailing Address - Phone:713-468-3344
Mailing Address - Fax:
Practice Address - Street 1:8830 LONG POINT RD
Practice Address - Street 2:SUITE 802
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3040
Practice Address - Country:US
Practice Address - Phone:713-468-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25580103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000320E3Medicaid
TX564178Medicare UPIN
TXP000320E3Medicaid