Provider Demographics
NPI:1831635978
Name:MOORE, LAUREN ALESE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALESE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ALESE
Other - Last Name:YAMASHITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 PACIFIC HILLS PT
Mailing Address - Street 2:APT. 305
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8442
Mailing Address - Country:US
Mailing Address - Phone:714-886-7655
Mailing Address - Fax:
Practice Address - Street 1:1025 PACIFIC HILLS PT
Practice Address - Street 2:APT. 305
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-8442
Practice Address - Country:US
Practice Address - Phone:714-886-7655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician