Provider Demographics
NPI:1033807540
Name:FOURNIER, LAUREN J
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:J
Last Name:FOURNIER
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 1:595 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-3303
Mailing Address - Country:US
Mailing Address - Phone:951-565-1879
Mailing Address - Fax:
Practice Address - Street 1:27990 SHERMAN RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-9155
Practice Address - Country:US
Practice Address - Phone:951-309-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician