Healthcare Provider Details

I. General information

NPI: 1053959080
Provider Name (Legal Business Name): LAURA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 04/22/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19623 S US HIGHWAY 377 # 1
DUBLIN TX
76446-4423
US

IV. Provider business mailing address

160 PRIVATE ROAD 1604
DUBLIN TX
76446-4971
US

V. Phone/Fax

Practice location:
  • Phone: 254-485-4671
  • Fax:
Mailing address:
  • Phone: 254-485-4671
  • Fax: 855-579-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number76422
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: