Provider Demographics
NPI:1508005604
Name:LECRENN, GEORGE (LAC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:LECRENN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8016 LEVATA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1947
Mailing Address - Country:US
Mailing Address - Phone:512-740-9501
Mailing Address - Fax:
Practice Address - Street 1:12016 W HWY 290 STE 4
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-2837
Practice Address - Country:US
Practice Address - Phone:512-740-9501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1101171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist