Provider Demographics
NPI:1780336891
Name:ZALKOVSKY, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ZALKOVSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GUN BARREL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75156-4401
Mailing Address - Country:US
Mailing Address - Phone:903-802-7170
Mailing Address - Fax:456-754-8366
Practice Address - Street 1:1823 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GUN BARREL CITY
Practice Address - State:TX
Practice Address - Zip Code:75156-4401
Practice Address - Country:US
Practice Address - Phone:903-802-7170
Practice Address - Fax:469-754-8366
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15552101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)