Provider Demographics
NPI:1992138283
Name:N OTOUPAL, PLLC
Entity type:Organization
Organization Name:N OTOUPAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OTOUPAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-501-3337
Mailing Address - Street 1:102 WONDER WORLD DR # 304-146
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-6076
Mailing Address - Country:US
Mailing Address - Phone:719-501-3337
Mailing Address - Fax:
Practice Address - Street 1:102 WONDER WORLD DR # 304-146
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6076
Practice Address - Country:US
Practice Address - Phone:719-501-3337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX329161901Medicaid