1184031551 NPI number — MRS. GENEVIA RAYLENE SLATE LPC

Table of content: MRS. GENEVIA RAYLENE SLATE LPC (NPI 1184031551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184031551 NPI number — MRS. GENEVIA RAYLENE SLATE LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLATE
Provider First Name:
GENEVIA
Provider Middle Name:
RAYLENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184031551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9460 W WESTRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ODESSA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79764-8923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-425-6978
Provider Business Mailing Address Fax Number:
432-366-0880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 E 37TH ST STE 111E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79762-6216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-425-6978
Provider Business Practice Location Address Fax Number:
432-366-0880
Provider Enumeration Date:
07/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  9780 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 69274 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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