Healthcare Provider Details

I. General information

NPI: 1770937138
Provider Name (Legal Business Name): LAUREN REPPY M.A. L.M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MISSION ST
SANTA CRUZ CA
95060-3611
US

IV. Provider business mailing address

539 SUMNER ST
SANTA CRUZ CA
95062-2532
US

V. Phone/Fax

Practice location:
  • Phone: 831-216-6522
  • Fax:
Mailing address:
  • Phone: 831-440-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number90684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: