Provider Demographics
NPI:1295419372
Name:ERP, LAUREN SHORT
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:SHORT
Last Name:ERP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANN
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 CIRCLE DR SE
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-4301
Mailing Address - Country:US
Mailing Address - Phone:985-259-1473
Mailing Address - Fax:
Practice Address - Street 1:4210 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3093
Practice Address - Country:US
Practice Address - Phone:601-261-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent