Provider Demographics
NPI:1497311039
Name:MCDOUGAL, LAUREN LOVE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LOVE
Last Name:MCDOUGAL
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 1:1401 SAINT EDWARDS DR APT 272
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6510
Mailing Address - Country:US
Mailing Address - Phone:504-427-3720
Mailing Address - Fax:
Practice Address - Street 1:1401 SAINT EDWARDS DR APT 272
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6510
Practice Address - Country:US
Practice Address - Phone:504-427-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
LAPLC9645101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician