Provider Demographics
NPI:1992936124
Name:MACK, LAWRENCE C JR (LPC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:C
Last Name:MACK
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9731 CEREMONY CV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-1850
Mailing Address - Country:US
Mailing Address - Phone:210-222-0152
Mailing Address - Fax:210-222-1392
Practice Address - Street 1:2391 NE LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5600
Practice Address - Country:US
Practice Address - Phone:210-222-0152
Practice Address - Fax:210-222-1392
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional