Provider Demographics
NPI:1780329060
Name:PLUSH, LAURYN
Entity type:Individual
Prefix:
First Name:LAURYN
Middle Name:
Last Name:PLUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 CAMINO DEL RIO S STE 215
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3837
Mailing Address - Country:US
Mailing Address - Phone:619-558-0001
Mailing Address - Fax:
Practice Address - Street 1:3333 CAMINO DEL RIO S STE 215
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3837
Practice Address - Country:US
Practice Address - Phone:619-558-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty