Provider Demographics
NPI:1598383069
Name:THREE FLEUR DE LIS INC
Entity Type:Organization
Organization Name:THREE FLEUR DE LIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-396-0604
Mailing Address - Street 1:2454 BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-8477
Mailing Address - Country:US
Mailing Address - Phone:719-396-1363
Mailing Address - Fax:985-601-2195
Practice Address - Street 1:5535 THURBER DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-2079
Practice Address - Country:US
Practice Address - Phone:719-396-0604
Practice Address - Fax:985-601-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-10
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty