Provider Demographics
NPI:1043559487
Name:GILLMAN, LAUREN MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:GILLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MICHELLE
Other - Last Name:HADDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 683128
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77268
Mailing Address - Country:US
Mailing Address - Phone:281-788-4913
Mailing Address - Fax:281-894-1422
Practice Address - Street 1:11820 CYPRESS CORNER LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-1132
Practice Address - Country:US
Practice Address - Phone:281-894-1423
Practice Address - Fax:281-894-1422
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0-12-5046103K00000X
TX1-13-14539103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst