=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053959908
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN TYE BOATMAN LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2019
-----------------------------------------------------
Last Update Date | 06/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 938 MAIN ST
-----------------------------------------------------
City | SULPHUR SPRINGS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75482-3829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-348-1156
-----------------------------------------------------
Fax | 903-765-7194
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 FARM ROAD 2560
-----------------------------------------------------
City | SULPHUR SPRINGS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75482-8706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-348-1156
-----------------------------------------------------
Fax | 903-765-7194
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 79941
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 79941
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YS0200X
-----------------------------------------------------
Taxonomy Name | School Counselor
-----------------------------------------------------
License Number | 79941
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 79941
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------