Provider Demographics
NPI:1245675446
Name:LAWRENCE, JULIEN
Entity type:Individual
Prefix:
First Name:JULIEN
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 121342
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76121-1342
Mailing Address - Country:US
Mailing Address - Phone:817-319-6046
Mailing Address - Fax:817-244-3242
Practice Address - Street 1:10141 CHAPEL OAK TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1234
Practice Address - Country:US
Practice Address - Phone:817-319-6046
Practice Address - Fax:817-244-3242
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30815171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications