Provider Demographics
NPI:1235425729
Name:WING, LAUREN MELISSA (MA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MELISSA
Last Name:WING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 LACA ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-6397
Mailing Address - Country:US
Mailing Address - Phone:702-577-8122
Mailing Address - Fax:
Practice Address - Street 1:1721 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-7812
Practice Address - Country:US
Practice Address - Phone:775-887-9338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00360-LC101YA0400X
FL6009101YM0800X
MI6401012831101YM0800X
NVCP0273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)