Healthcare Provider Details

I. General information

NPI: 1154938256
Provider Name (Legal Business Name): LEJEUNE HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 CASTLE HOLLOW DR
SPRING TX
77389-1412
US

IV. Provider business mailing address

6810 CASTLE HOLLOW DR
SPRING TX
77389-1412
US

V. Phone/Fax

Practice location:
  • Phone: 281-732-4038
  • Fax:
Mailing address:
  • Phone: 281-732-4038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY YOUNG
Title or Position: CEO
Credential:
Phone: 281-732-4038