Provider Demographics
NPI:1801260427
Name:VANZUIDEN, LAUREN LISA MIKA
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:LISA MIKA
Last Name:VANZUIDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 HIGHTOWER TRAIL
Mailing Address - Street 2:B120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350
Mailing Address - Country:US
Mailing Address - Phone:866-750-5554
Mailing Address - Fax:678-540-4460
Practice Address - Street 1:1215 HIGHTOWER TRAIL
Practice Address - Street 2:B120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350
Practice Address - Country:US
Practice Address - Phone:866-750-5554
Practice Address - Fax:678-540-4460
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-19774103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst