Healthcare Provider Details

I. General information

NPI: 1003246570
Provider Name (Legal Business Name): LAUREN ASHLEY OGREN M.A., MFT, LPCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2013
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 C ST SUITE D
SAN RAFAEL CA
94901-3857
US

IV. Provider business mailing address

710 C ST SUITE D
SAN RAFAEL CA
94901-3857
US

V. Phone/Fax

Practice location:
  • Phone: 415-488-6650
  • Fax:
Mailing address:
  • Phone: 415-488-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT83783
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPCCI241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: