Individual
LAURA P ICHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 W WILLIAM CANNON DR STE 703, AUSTIN, TX 78745-5252
(512) 203-4758
Mailing address
7908 CRANDALL RD, AUSTIN, TX 78739-1910
(512) 203-4758
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
19162
TX
Other
Enumeration date
01/17/2022
Last updated
01/17/2022
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