Provider Demographics
NPI:1083119507
Name:LEMOHN, LAUREL
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:LEMOHN
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 1:1330 LINCOLN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2142
Mailing Address - Country:US
Mailing Address - Phone:415-459-5999
Mailing Address - Fax:415-459-5602
Practice Address - Street 1:137 E OAK ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-3610
Practice Address - Country:US
Practice Address - Phone:707-961-0172
Practice Address - Fax:844-388-6167
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist