1790076339 NPI number — MARLA JANAE FLOURNOY LPC, LSSP, BCBA

Table of content: MARLA JANAE FLOURNOY LPC, LSSP, BCBA (NPI 1790076339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790076339 NPI number — MARLA JANAE FLOURNOY LPC, LSSP, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLOURNOY
Provider First Name:
MARLA
Provider Middle Name:
JANAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, LSSP, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOUNG
Provider Other First Name:
MARLA
Provider Other Middle Name:
JANAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790076339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10109 ANTELOPE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75126-7879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-893-7795
Provider Business Mailing Address Fax Number:
972-564-6966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10109 ANTELOPE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75126-7879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-893-7795
Provider Business Practice Location Address Fax Number:
972-564-6966
Provider Enumeration Date:
05/01/2011

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:  59852 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103K00000X , with the licence number: 1-09-5513 , 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)