MEDICARE: MRS. LAURA A ADDICKS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	41087	TX

General Provider Information

NPI Number	:	1871265082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA A ADDICKS LCSW

Provider Business Mailing Address
First Line	:	602 DOVER HEIGHTS TRL
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-2860
Country	:	US
Telephone Number	:	717-734-8072
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 DOVER HEIGHTS TRL
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-2860
Country	:	US
Telephone Number	:	717-734-8072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2021
Last Update Date	:	10/05/2021

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