Provider Demographics
NPI:1316722515
Name:ABBOTT, LAREN C (MFT INTERN)
Entity type:Individual
Prefix:MR
First Name:LAREN
Middle Name:C
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 VILLAGE CENTER CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-0515
Mailing Address - Country:US
Mailing Address - Phone:725-735-2700
Mailing Address - Fax:
Practice Address - Street 1:450 HILLSIDE DR STE A108
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-3102
Practice Address - Country:US
Practice Address - Phone:725-735-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist