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General NPI Number Information
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NPI Number | 1407952161
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Entity Type | Individual
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Provider Name | LAURENCE EDWARD OUELLETTE LPC
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 805 W 10TH ST SUITE 300
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City | AUSTIN
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State | TX
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Zip | 78701-2047
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Country | US
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Telephone | 512-912-6332
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 180542
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City | AUSTIN
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State | TX
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Zip | 78718-0542
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Country | US
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Telephone | 512-912-6332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 63154
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License Number State | TX
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