Provider Demographics
NPI:1548009053
Name:EBADY, LAURA (PSYD, CGP)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:EBADY
Suffix:
Gender:F
Credentials:PSYD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1823
Mailing Address - Country:US
Mailing Address - Phone:512-689-6755
Mailing Address - Fax:
Practice Address - Street 1:4315 GUADALUPE ST STE 208
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-3644
Practice Address - Country:US
Practice Address - Phone:512-689-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32945103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical