Healthcare Provider Details

I. General information

NPI: 1770107435
Provider Name (Legal Business Name): LAUREN SALAZAR MA, LMFTA, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 N 9TH ST STE 230
NOBLESVILLE IN
46060-2208
US

IV. Provider business mailing address

9946 W HAVEN CIR APT B
INDIANAPOLIS IN
46280-2769
US

V. Phone/Fax

Practice location:
  • Phone: 317-645-7691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number850003333A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: