Provider Demographics
NPI:1194429241
Name:BAUER, LAURA (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 BOONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77808-2326
Mailing Address - Country:US
Mailing Address - Phone:979-703-1808
Mailing Address - Fax:
Practice Address - Street 1:2490 BOONVILLE RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-2326
Practice Address - Country:US
Practice Address - Phone:979-703-1808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX686691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical