Provider Demographics
NPI:1053426544
Name:BRANNAN, LAURA KAY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KAY
Last Name:BRANNAN
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 1:1160 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-2303
Mailing Address - Country:US
Mailing Address - Phone:817-457-0682
Mailing Address - Fax:817-451-4104
Practice Address - Street 1:1160 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-2303
Practice Address - Country:US
Practice Address - Phone:817-457-0682
Practice Address - Fax:817-451-4104
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX064001301Medicaid
TX241678OtherAMERIGROUP TEXAS