Healthcare Provider Details

I. General information

NPI: 1508123761
Provider Name (Legal Business Name): LAUREN BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21303 W 95TH TER
LENEXA KS
66220-5603
US

IV. Provider business mailing address

21303 W 95TH TER
LENEXA KS
66220-5603
US

V. Phone/Fax

Practice location:
  • Phone: 702-807-3554
  • Fax:
Mailing address:
  • Phone: 702-807-3554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberK02-79-4495
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: