Provider Demographics
NPI:1053509240
Name:LEMELLE, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:LEMELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30443 BETKA RD
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-4952
Mailing Address - Country:US
Mailing Address - Phone:936-372-9007
Mailing Address - Fax:936-372-3003
Practice Address - Street 1:30443 BETKA RD
Practice Address - Street 2:
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-4952
Practice Address - Country:US
Practice Address - Phone:936-372-9007
Practice Address - Fax:936-372-3003
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX610175171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator