Provider Demographics
NPI:1083098057
Name:FIX, LAUREN W (PHD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:W
Last Name:FIX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 DEVILLE LN
Mailing Address - Street 2:HWY 167 SOUTH
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-6313
Mailing Address - Country:US
Mailing Address - Phone:318-355-1322
Mailing Address - Fax:
Practice Address - Street 1:902 DEVILLE LN
Practice Address - Street 2:HWY 167 SOUTH
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-6313
Practice Address - Country:US
Practice Address - Phone:318-355-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-19
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5026101YP2500X
LA1182106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist