Provider Demographics
NPI:1275273450
Name:LAURITZEN, SEREN (EDS)
Entity Type:Individual
Prefix:
First Name:SEREN
Middle Name:
Last Name:LAURITZEN
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 1:3056 E VERMONT DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1469
Mailing Address - Country:US
Mailing Address - Phone:801-372-2495
Mailing Address - Fax:
Practice Address - Street 1:3056 E VERMONT DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1469
Practice Address - Country:US
Practice Address - Phone:801-372-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool