Provider Demographics
NPI:1194024075
Name:VAN DE LAAR, BRECHTJE CORNELIA (LMSW)
Entity type:Individual
Prefix:MS
First Name:BRECHTJE
Middle Name:CORNELIA
Last Name:VAN DE LAAR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19701 KINGWOOD DR
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3773
Mailing Address - Country:US
Mailing Address - Phone:281-358-5701
Mailing Address - Fax:281-358-7061
Practice Address - Street 1:19701 KINGWOOD DR
Practice Address - Street 2:BUILDING 3
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3773
Practice Address - Country:US
Practice Address - Phone:281-358-5701
Practice Address - Fax:281-358-7061
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX531501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical