Provider Demographics
NPI:1861811861
Name:LAURA GONZALES LCSW
Entity type:Organization
Organization Name:LAURA GONZALES LCSW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:225-450-6616
Mailing Address - Street 1:1026 E WORTHY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4302
Mailing Address - Country:US
Mailing Address - Phone:225-450-6616
Mailing Address - Fax:225-450-6615
Practice Address - Street 1:1026 E WORTHY ST
Practice Address - Street 2:SUITE A
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4302
Practice Address - Country:US
Practice Address - Phone:225-450-6616
Practice Address - Fax:225-450-6615
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAURA GONZALES, LCSW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-08
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2394517Medicaid
LA2394517Medicaid