Provider Demographics
NPI:1679832687
Name:VAILLANCOURT, LOIS (LPC-S)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:VAILLANCOURT
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 SANDHURST LN
Mailing Address - Street 2:STE. A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4925
Mailing Address - Country:US
Mailing Address - Phone:214-991-6280
Mailing Address - Fax:
Practice Address - Street 1:5805 SANDHURST LN
Practice Address - Street 2:STE. A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4925
Practice Address - Country:US
Practice Address - Phone:214-991-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18928101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional