Provider Demographics
NPI:1851018535
Name:LAWLESS, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LAWLESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2886 CALL CT
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-4453
Mailing Address - Country:US
Mailing Address - Phone:916-708-7705
Mailing Address - Fax:
Practice Address - Street 1:2886 CALL CT
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-4453
Practice Address - Country:US
Practice Address - Phone:916-708-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician