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General NPI Number Information
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NPI Number | 1811792484
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Entity Type | Organization
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Legal Business Name | LAKEWELL ABA LLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 1431 MENDELL DR
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City | SAINT LOUIS
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State | MO
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Zip | 63130-1213
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Country | US
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Telephone | 314-328-7748
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Fax | 713-583-3419
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Provider Business Mailing Address
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Address Line | 2368A RICE BLVD STE 108
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City | HOUSTON
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State | TX
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Zip | 77005-2652
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Country | US
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Telephone | 314-328-7748
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Fax | 713-583-3419
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAMARA ANGELLE ALEXANDER
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Credential |
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Telephone | 314-328-7748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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