Provider Demographics
NPI:1588909931
Name:CHAVIS, LAUREN (PSYD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CHAVIS
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 1:1065 E WINDING CREEK DR STE 250
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7246
Mailing Address - Country:US
Mailing Address - Phone:208-423-8375
Mailing Address - Fax:
Practice Address - Street 1:1065 E WINDING CREEK DR STE 250
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7246
Practice Address - Country:US
Practice Address - Phone:208-423-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-203813103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty