1891424263 NPI number — LAUREN NICOLA MARRIAGE AND FAMILY THERAPIST, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891424263 NPI number — LAUREN NICOLA MARRIAGE AND FAMILY THERAPIST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAUREN NICOLA MARRIAGE AND FAMILY THERAPIST, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1891424263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1803 N ALLEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91104-1614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-920-6014
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1803 N ALLEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91104-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-920-6014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BURKE-NICOLA
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
ROSE
Authorized Official Title or Position:
FOUNDER
Authorized Official Telephone Number:
310-920-6014

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com