Provider Demographics
NPI:1962774562
Name:SMART, LAUREN ALIDA (LPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALIDA
Last Name:SMART
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:UCB 119 PHP
Mailing Address - Street 2:UNIVERSITY OF COLORADO - WARDENBURG STUDENT HEALTH CENT
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80309-0119
Mailing Address - Country:US
Mailing Address - Phone:303-492-5654
Mailing Address - Fax:303-735-1900
Practice Address - Street 1:UNIVERSITY OF COLORADO WARDENBURG CTR
Practice Address - Street 2:UCB 119 PHP
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-0119
Practice Address - Country:US
Practice Address - Phone:303-492-5654
Practice Address - Fax:303-735-1900
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1617101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional