Provider Demographics
NPI:1427511450
Name:MCDANIELS, LAUREN PAIGE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:PAIGE
Last Name:MCDANIELS
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 1:535 N BRAND BLVD STE 502
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1962
Mailing Address - Country:US
Mailing Address - Phone:877-206-1009
Mailing Address - Fax:
Practice Address - Street 1:326 CANFIELD AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2189
Practice Address - Country:US
Practice Address - Phone:909-618-9751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty