Provider Demographics
NPI:1922724152
Name:PARKER, LAUREN R (PSYS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:R
Last Name:PARKER
Suffix:
Gender:F
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 TROTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER SPGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-6211
Mailing Address - Country:US
Mailing Address - Phone:772-486-2184
Mailing Address - Fax:
Practice Address - Street 1:1128 TROTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:WINTER SPGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6211
Practice Address - Country:US
Practice Address - Phone:772-486-2184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool