Provider Demographics
NPI:1639925035
Name:LAVEAU, QUERBY LOVE
Entity type:Individual
Prefix:
First Name:QUERBY
Middle Name:LOVE
Last Name:LAVEAU
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 1:11250 BRIAR FOREST DR APT 281
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2274
Mailing Address - Country:US
Mailing Address - Phone:941-763-7909
Mailing Address - Fax:
Practice Address - Street 1:11250 BRIAR FOREST DR APT 281
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2274
Practice Address - Country:US
Practice Address - Phone:941-763-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-7850-590434106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician