Healthcare Provider Details

I. General information

NPI: 1811745631
Provider Name (Legal Business Name): KRISTEN LASH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 GREENBRIAR DR
SOUTHLAKE TX
76092-8355
US

IV. Provider business mailing address

7709 FRANKIE B ST
NORTH RICHLAND HILLS TX
76182-3912
US

V. Phone/Fax

Practice location:
  • Phone: 817-984-8655
  • Fax:
Mailing address:
  • Phone: 817-349-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-332826
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: