Provider Demographics
NPI:1508313487
Name:HARTLEY NGUYEN, LAUREN ELYSE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELYSE
Last Name:HARTLEY NGUYEN
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 1:1197 THREE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4622
Mailing Address - Country:US
Mailing Address - Phone:601-832-0821
Mailing Address - Fax:
Practice Address - Street 1:1197 THREE MEADOWS DR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4622
Practice Address - Country:US
Practice Address - Phone:601-832-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst