Provider Demographics
NPI:1033329016
Name:HEDGES, LAWRENCE EUGENE
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:EUGENE
Last Name:HEDGES
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 1:1439 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2228
Mailing Address - Country:US
Mailing Address - Phone:714-633-3933
Mailing Address - Fax:714-633-3933
Practice Address - Street 1:1439 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2228
Practice Address - Country:US
Practice Address - Phone:714-633-3933
Practice Address - Fax:714-633-3933
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPL 003567103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist