Healthcare Provider Details

I. General information

NPI: 1073706842
Provider Name (Legal Business Name): LENA LOIS LAXTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12604 PALOMA BLANCA WAY
DEL VALLE TX
78617-3601
US

IV. Provider business mailing address

12604 PALOMA BLANCA WAY
DEL VALLE TX
78617-3601
US

V. Phone/Fax

Practice location:
  • Phone: 512-786-9556
  • Fax:
Mailing address:
  • Phone: 512-786-9556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number62020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: