Healthcare Provider Details

I. General information

NPI: 1619145828
Provider Name (Legal Business Name): LAURIE ENIS PAXSON LOC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N BISHOP ST
SAN MARCOS TX
78666-2706
US

IV. Provider business mailing address

819 WATER ST STE 300
KERRVILLE TX
78028-5330
US

V. Phone/Fax

Practice location:
  • Phone: 512-392-7151
  • Fax: 512-392-5444
Mailing address:
  • Phone: 830-258-5430
  • Fax: 830-792-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15165
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: