Provider Demographics
NPI:1568091791
Name:GOTTERER, LAUREN ADELYN (PSYD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ADELYN
Last Name:GOTTERER
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-5075
Mailing Address - Country:US
Mailing Address - Phone:512-859-6591
Mailing Address - Fax:
Practice Address - Street 1:1613 W 6TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5075
Practice Address - Country:US
Practice Address - Phone:512-859-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34289103TC0700X, 103TC2200X, 103T00000X
TX40574103TC0700X, 103T00000X
103T00000X
NC6256103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist