Provider Demographics
NPI:1588085112
Name:GONZALES, LAURA ANN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16558 JAY RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-6270
Mailing Address - Country:US
Mailing Address - Phone:225-803-5145
Mailing Address - Fax:
Practice Address - Street 1:16558 JAY RD
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-6270
Practice Address - Country:US
Practice Address - Phone:225-803-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-28
Last Update Date:2013-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health