Provider Demographics
NPI:1730533787
Name:AUSTIN, LAUREN (LMFT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2414
Mailing Address - Country:US
Mailing Address - Phone:209-577-1667
Mailing Address - Fax:209-577-3805
Practice Address - Street 1:706 13TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2414
Practice Address - Country:US
Practice Address - Phone:209-577-1667
Practice Address - Fax:209-577-3805
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39811106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist