Provider Demographics
NPI:1700099496
Name:LAMORE, MARK STEPHEN
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEPHEN
Last Name:LAMORE
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:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:CA
Mailing Address - Zip Code:93432-0432
Mailing Address - Country:US
Mailing Address - Phone:805-234-6142
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 15408
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93406-5408
Practice Address - Country:US
Practice Address - Phone:805-541-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2020-02-26
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2020-02-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health