Provider Demographics
NPI:1992309843
Name:BLALOCK BOCHNER, LAUREN (AMFT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BLALOCK BOCHNER
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BLALOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AMFT
Mailing Address - Street 1:1198 S BRONSON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3236
Mailing Address - Country:US
Mailing Address - Phone:312-848-5706
Mailing Address - Fax:
Practice Address - Street 1:11980 SAN VICENTE BLVD STE 909
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6607
Practice Address - Country:US
Practice Address - Phone:213-537-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104087101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health