Provider Demographics
NPI:1558170563
Name:SEYMOUR, LAUREN (BS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3667 W FURCULA DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-6060
Mailing Address - Country:US
Mailing Address - Phone:818-517-8229
Mailing Address - Fax:
Practice Address - Street 1:3667 W FURCULA DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-6060
Practice Address - Country:US
Practice Address - Phone:818-517-8229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician