Provider Demographics
NPI:1992843338
Name:CHRISTIANSON, LAUREN MCRAE (MA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MCRAE
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3129
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70664-3129
Mailing Address - Country:US
Mailing Address - Phone:337-528-2624
Mailing Address - Fax:
Practice Address - Street 1:2400 MERGANSER ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70615-6898
Practice Address - Country:US
Practice Address - Phone:337-433-6739
Practice Address - Fax:337-802-0810
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA925101YA0400X
LA3473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)