Healthcare Provider Details

I. General information

NPI: 1669369997
Provider Name (Legal Business Name): LAUTEN DAWN ESCOBEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 N SWENSON ST
STAMFORD TX
79553-2909
US

IV. Provider business mailing address

1408 COMPTON ST
STAMFORD TX
79553-6104
US

V. Phone/Fax

Practice location:
  • Phone: 325-733-2511
  • Fax:
Mailing address:
  • Phone: 325-733-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number93322
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: