Provider Demographics
NPI:1508338526
Name:MCAMIS, LAUREN C
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:C
Last Name:MCAMIS
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 1:617 BAYONET CIR
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-4600
Mailing Address - Country:US
Mailing Address - Phone:831-920-0921
Mailing Address - Fax:831-221-5220
Practice Address - Street 1:617 BAYONET CIR
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-4600
Practice Address - Country:US
Practice Address - Phone:831-920-0921
Practice Address - Fax:831-221-5220
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108421106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty