Provider Demographics
NPI:1730199217
Name:BLACK, LAURA KAY (LPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KAY
Last Name:BLACK
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 1:6801 OAK VW
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-4877
Mailing Address - Country:US
Mailing Address - Phone:254-933-1337
Mailing Address - Fax:254-933-1337
Practice Address - Street 1:600 FOREST DR
Practice Address - Street 2:SUITE H
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-2800
Practice Address - Country:US
Practice Address - Phone:254-933-1113
Practice Address - Fax:254-933-1113
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19168101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1787822Medicaid