Provider Demographics
NPI:1548093206
Name:LAWRENCE, SEAN ANDREW
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:ANDREW
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ARROWHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524-8608
Mailing Address - Country:US
Mailing Address - Phone:707-494-3092
Mailing Address - Fax:
Practice Address - Street 1:201 W MAIN ST STE 4B
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2734
Practice Address - Country:US
Practice Address - Phone:541-281-9026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool