Healthcare Provider Details

I. General information

NPI: 1700379864
Provider Name (Legal Business Name): LUBNAA BADRIYYAH ABDULLAH LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 CENTER POINT DR
EDINBURG TX
78539-8433
US

IV. Provider business mailing address

3115 CENTER POINT DR
EDINBURG TX
78539-8433
US

V. Phone/Fax

Practice location:
  • Phone: 956-296-1987
  • Fax: 956-630-0074
Mailing address:
  • Phone: 956-296-1987
  • Fax: 956-630-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number38614
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: