Provider Demographics
NPI:1790076339
Name:FLOURNOY, MARLA JANAE (LPC, LSSP, BCBA)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:JANAE
Last Name:FLOURNOY
Suffix:
Gender:F
Credentials:LPC, LSSP, BCBA
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:JANAE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10109 ANTELOPE WAY
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-7879
Mailing Address - Country:US
Mailing Address - Phone:214-893-7795
Mailing Address - Fax:972-564-6966
Practice Address - Street 1:10109 ANTELOPE WAY
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-7879
Practice Address - Country:US
Practice Address - Phone:214-893-7795
Practice Address - Fax:972-564-6966
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-01
Last Update Date:2011-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59852101YP2500X
TX1-09-5513103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst