Healthcare Provider Details

I. General information

NPI: 1780903559
Provider Name (Legal Business Name): THERESE LEBEAU MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 DUNLAVY ST APT 3
HOUSTON TX
77006-1749
US

IV. Provider business mailing address

2212 DUNLAVY ST APT 3
HOUSTON TX
77006-1749
US

V. Phone/Fax

Practice location:
  • Phone: 713-665-7669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDT81093
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: