Provider Demographics
NPI:1629372032
Name:JOHNSON, LAUREN BETH (PHD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:BETH
Other - Last Name:FLEGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1000 N 90TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2764
Mailing Address - Country:US
Mailing Address - Phone:402-955-3900
Mailing Address - Fax:402-955-3920
Practice Address - Street 1:1000 N 90TH ST
Practice Address - Street 2:STE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2764
Practice Address - Country:US
Practice Address - Phone:402-955-3900
Practice Address - Fax:402-955-3920
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE913103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical