Provider Demographics
NPI:1144815259
Name:SULAK, TRISHA LORRAINE (RBT)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:LORRAINE
Last Name:SULAK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:LORRAINE
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2385 COUNTY ROAD 1020
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-3412
Mailing Address - Country:US
Mailing Address - Phone:254-630-7257
Mailing Address - Fax:
Practice Address - Street 1:2406 COUNTY ROAD 1020
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-3550
Practice Address - Country:US
Practice Address - Phone:254-630-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-21-158282106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician