Provider Demographics
NPI:1215450077
Name:KIM-BAE, LAUREN (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:KIM-BAE
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BAE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:6425 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-1675
Mailing Address - Country:US
Mailing Address - Phone:612-798-8187
Mailing Address - Fax:
Practice Address - Street 1:3200 HIGHWAY 100 S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2175
Practice Address - Country:US
Practice Address - Phone:052-915-4251
Practice Address - Fax:952-920-2068
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4302103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical