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General NPI Number Information
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NPI Number | 1790168680
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Entity Type | Individual
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Provider Name | LAUREN CORBETT MAHAN M.S.
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Gender | Female
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 480 MONTGOMERY LANE
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City | PORT LUDLOW
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State | WA
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Zip | 98365-8052
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Country | US
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Telephone | 360-900-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 480 MONTGOMERY LANE
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City | PORT LUDLOW
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State | WA
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Zip | 98365-8052
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Country | US
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Telephone | 360-900-6100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 13-17-13719
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License Number State | CA
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