Healthcare Provider Details

I. General information

NPI: 1083132559
Provider Name (Legal Business Name): LAUREN FOUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MIDLAND AVE STE 15B
BASALT CO
81621-8119
US

IV. Provider business mailing address

PO BOX 1115
BASALT CO
81621-1115
US

V. Phone/Fax

Practice location:
  • Phone: 970-925-5858
  • Fax:
Mailing address:
  • Phone: 970-925-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: