Healthcare Provider Details

I. General information

NPI: 1457555393
Provider Name (Legal Business Name): LAUREN KIM STOWE BA SOCIAL WORK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 W TOWN AND COUNTRY RD
ORANGE CA
92868-4712
US

IV. Provider business mailing address

2960 E JACKSON AVE APT 9
ANAHEIM CA
92806-3455
US

V. Phone/Fax

Practice location:
  • Phone: 714-547-7559
  • Fax: 714-543-4431
Mailing address:
  • Phone: 714-630-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: