Provider Demographics
NPI:1730598194
Name:CANNIFF, LAUREN MEADOWS (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MEADOWS
Last Name:CANNIFF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:408 N KENDRICK ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1582
Mailing Address - Country:US
Mailing Address - Phone:928-774-6364
Mailing Address - Fax:928-556-0504
Practice Address - Street 1:408 N KENDRICK ST
Practice Address - Street 2:SUITE 4
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1582
Practice Address - Country:US
Practice Address - Phone:928-774-6364
Practice Address - Fax:928-556-0504
Is Sole Proprietor?:No
Enumeration Date:2014-08-10
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4536103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical