Provider Demographics
NPI:1598218273
Name:LAUDERDALE, NAAMAN (LPCC, MAC,THD)
Entity Type:Individual
Prefix:PROF
First Name:NAAMAN
Middle Name:
Last Name:LAUDERDALE
Suffix:
Gender:M
Credentials:LPCC, MAC,THD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 MELVILLE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4512
Mailing Address - Country:US
Mailing Address - Phone:314-762-6363
Mailing Address - Fax:877-819-8247
Practice Address - Street 1:569 MELVILLE AVE STE 202
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4512
Practice Address - Country:US
Practice Address - Phone:314-762-6363
Practice Address - Fax:877-819-8247
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X
CALR02110616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health