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General NPI Number Information
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NPI Number | 1891413019
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Entity Type | Individual
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Provider Name | MS. LAURIE ANN EVANS
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Gender | Female
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 433 KITTY HAWK RD STE 211
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City | UNIVERSAL CITY
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State | TX
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Zip | 78148-3829
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Country | US
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Telephone | 210-763-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 14706 AEGEAN WAY
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City | SELMA
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State | TX
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Zip | 78154-3400
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Country | US
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Telephone | 210-505-6484
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 66744
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License Number State | TX
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