1023772134 NPI number — MRS. LAUREN DEBLANC POOLE BCBA, LBA

Table of content: MRS. LAUREN DEBLANC POOLE BCBA, LBA (NPI 1023772134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023772134 NPI number — MRS. LAUREN DEBLANC POOLE BCBA, LBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POOLE
Provider First Name:
LAUREN
Provider Middle Name:
DEBLANC
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BCBA, LBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEBLANC
Provider Other First Name:
LAUREN
Provider Other Middle Name:
ELISABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BCBA, LBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023772134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 SAN FELIPE ST STE 990
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77063-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-826-3382
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2424 VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78521-1480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-431-0056
Provider Business Practice Location Address Fax Number:
832-553-7287
Provider Enumeration Date:
10/25/2021

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: 103K00000X , with the licence number:  L-579 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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