Basic Information
| Provider Information | |||||||||
| NPI: | 1508338526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCAMIS | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 BAYONET CIR | ||||||||
| Address2: | |||||||||
| City: | MARINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939334600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8319200921 | ||||||||
| FaxNumber: | 8312215220 | ||||||||
| Practice Location | |||||||||
| Address1: | 617 BAYONET CIR | ||||||||
| Address2: | |||||||||
| City: | MARINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939334600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8319200921 | ||||||||
| FaxNumber: | 8312215220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2019 | ||||||||
| LastUpdateDate: | 01/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 108421 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.