Provider Demographics
NPI:1407298045
Name:LAVENDER, LAUREN ALI (MA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALI
Last Name:LAVENDER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:A
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1700 7TH AVE STE 2100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1360
Mailing Address - Country:US
Mailing Address - Phone:406-781-8321
Mailing Address - Fax:
Practice Address - Street 1:1700 7TH AVE STE 2100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1360
Practice Address - Country:US
Practice Address - Phone:406-781-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional