Provider Demographics
NPI:1710751292
Name:DOCTOR OF BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:DOCTOR OF BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:LARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:832-294-8270
Mailing Address - Street 1:4377 SPRING BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-2601
Mailing Address - Country:US
Mailing Address - Phone:832-294-8270
Mailing Address - Fax:
Practice Address - Street 1:4377 SPRING BRANCH RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-2601
Practice Address - Country:US
Practice Address - Phone:832-294-8270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty