Provider Demographics
NPI:1306438098
Name:PENA, LAURIE ANN (MS, LCDC, LPC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:PENA
Suffix:
Gender:F
Credentials:MS, LCDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 CENTER POINT DR STE 3
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-4804
Mailing Address - Country:US
Mailing Address - Phone:979-412-3028
Mailing Address - Fax:
Practice Address - Street 1:3118 CENTER POINT DR STE 3
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-4804
Practice Address - Country:US
Practice Address - Phone:956-687-8000
Practice Address - Fax:956-687-8009
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional