1124291216 NPI number — MARY SAINT DUMLAO MED, LPC-S

Table of content: MARY SAINT DUMLAO MED, LPC-S (NPI 1124291216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124291216 NPI number — MARY SAINT DUMLAO MED, LPC-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUMLAO
Provider First Name:
MARY
Provider Middle Name:
SAINT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MED, LPC-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAINT
Provider Other First Name:
MARY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MED, LPC-S
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1124291216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30903 VICKIE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAGNOLIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77354-5712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-250-1141
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17510 HUFFMEISTER RD., SUITE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CYPRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77429-7831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-250-1141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  18429 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YS0200X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)