Provider Demographics
NPI:1558884528
Name:MEDLIN, LAUREN COLLINS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:COLLINS
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 CENTRAL AVE UNIT 616
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1678
Mailing Address - Country:US
Mailing Address - Phone:803-924-3383
Mailing Address - Fax:
Practice Address - Street 1:360 CENTRAL AVE STE 1230
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3865
Practice Address - Country:US
Practice Address - Phone:803-924-3383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10991103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist