Healthcare Provider Details

I. General information

NPI: 1578121489
Provider Name (Legal Business Name): LAURIE ANNE OBRIEN-CASEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURIE ANNE OBRIEN

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 KITTY HAWK RD STE 211
UNIVERSAL CITY TX
78148-3829
US

IV. Provider business mailing address

433 KITTY HAWK RD STE 211
UNIVERSAL CITY TX
78148-3829
US

V. Phone/Fax

Practice location:
  • Phone: 210-727-5515
  • Fax: 210-598-1910
Mailing address:
  • Phone: 210-727-5515
  • Fax: 210-598-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number66285
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: