Healthcare Provider Details

I. General information

NPI: 1801677208
Provider Name (Legal Business Name): LAUREN ALEXIS SKYE SEGOVIA CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL DR
LAKEWAY TX
78734-4200
US

IV. Provider business mailing address

412 E WILLIAM CANNON DR APT 1023
AUSTIN TX
78745-5773
US

V. Phone/Fax

Practice location:
  • Phone: 512-263-4500
  • Fax:
Mailing address:
  • Phone: 956-475-4125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number86361
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: