Provider Demographics
NPI:1801514336
Name:JAGANNATHAN, LAKSHMI
Entity type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:JAGANNATHAN
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 1:14280 LUTHERIA WAY
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-5976
Mailing Address - Country:US
Mailing Address - Phone:503-515-2561
Mailing Address - Fax:
Practice Address - Street 1:14280 LUTHERIA WAY
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5976
Practice Address - Country:US
Practice Address - Phone:503-515-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist