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General NPI Number Information
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NPI Number | 1801463872
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Entity Type | Individual
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Provider Name | LAVERNA SOUCIE
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Gender | Female
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 2435 E SOUTHLAKE BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6679
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Country | US
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Telephone | 817-812-2880
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 220395
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City | EL PASO
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State | TX
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Zip | 79913-2395
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 12381
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5736
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 82600
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License Number State | TX
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