Provider Demographics
NPI:1093920365
Name:COE, LAUREN B (EDS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:B
Last Name:COE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 N 83RD AVE
Mailing Address - Street 2:APT 2021
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4624
Mailing Address - Country:US
Mailing Address - Phone:623-734-7919
Mailing Address - Fax:
Practice Address - Street 1:14300 N 83RD AVE
Practice Address - Street 2:APT 2021
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4624
Practice Address - Country:US
Practice Address - Phone:623-734-7919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3671100103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool