Provider Demographics
NPI:1275855611
Name:MAHALIK, LAUREN (MS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MAHALIK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:MAHALIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:7155 MISSION GORGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1130
Mailing Address - Country:US
Mailing Address - Phone:858-300-0460
Mailing Address - Fax:858-300-0461
Practice Address - Street 1:7155 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-1130
Practice Address - Country:US
Practice Address - Phone:858-300-0460
Practice Address - Fax:858-300-0461
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A101YM0800X
CA61697106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health