Healthcare Provider Details

I. General information

NPI: 1174377048
Provider Name (Legal Business Name): JUSTINE LASLEY LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 283
STINNETT TX
79083-0283
US

IV. Provider business mailing address

PO BOX 283
STINNETT TX
79083-0283
US

V. Phone/Fax

Practice location:
  • Phone: 806-274-0979
  • Fax:
Mailing address:
  • Phone: 806-274-0979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number94536
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: