Provider Demographics
NPI:1417220583
Name:HARRELL, LAUREN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:HARRELL
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 1:13601 PRESTON RD
Mailing Address - Street 2:SUITE 415W
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:74524-4949
Mailing Address - Country:US
Mailing Address - Phone:240-235-5895
Mailing Address - Fax:972-559-3634
Practice Address - Street 1:13601 PRESTON RD
Practice Address - Street 2:SUITE 415W
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:74524-4949
Practice Address - Country:US
Practice Address - Phone:240-235-5895
Practice Address - Fax:972-559-3634
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82207133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered