Provider Demographics
NPI:1679111884
Name:HEAD, LAURA (MT-BC, NMT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HEAD
Suffix:
Gender:F
Credentials:MT-BC, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 ARAPAHO RD APT 2040
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-3628
Mailing Address - Country:US
Mailing Address - Phone:214-226-0042
Mailing Address - Fax:
Practice Address - Street 1:5930 ARAPAHO RD APT 2040
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-3628
Practice Address - Country:US
Practice Address - Phone:214-226-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13306225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist