Provider Demographics
NPI:1053959908
Name:BOATMAN, LAUREN TYE (LPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:TYE
Last Name:BOATMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 FARM ROAD 2560
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-8706
Mailing Address - Country:US
Mailing Address - Phone:903-348-1156
Mailing Address - Fax:903-765-7194
Practice Address - Street 1:938 MAIN ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-3829
Practice Address - Country:US
Practice Address - Phone:903-348-1156
Practice Address - Fax:903-765-7194
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79941101Y00000X, 101YP2500X, 101YS0200X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool