Healthcare Provider Details

I. General information

NPI: 1265152797
Provider Name (Legal Business Name): THU LE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 10/31/2023
Certification Date: 10/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4722 RIVERSTONE BLVD STE 100
MISSOURI CITY TX
77459-4723
US

IV. Provider business mailing address

4722 RIVERSTONE BLVD STE 100
MISSOURI CITY TX
77459-4723
US

V. Phone/Fax

Practice location:
  • Phone: 346-368-4412
  • Fax:
Mailing address:
  • Phone: 346-368-4412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69127
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: