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General NPI Number Information
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NPI Number | 1548009053
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Entity Type | Individual
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Provider Name | LAURA EBADY PSYD, CGP
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Gender | Female
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Dates
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Enumeration Date | 05/23/2024
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 4315 GUADALUPE ST STE 208
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City | AUSTIN
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State | TX
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Zip | 78751-3644
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Country | US
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Telephone | 512-689-6755
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Fax |
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Provider Business Mailing Address
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Address Line | 1705 W 30TH ST
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City | AUSTIN
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State | TX
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Zip | 78703-1823
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Country | US
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Telephone | 512-689-6755
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 32945
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License Number State | TX
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