Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | PCCI241 | CA |
NPI | 1003246570 |
---|---|
Provider Name | Lauren Ashley Ogren |
First Address | San Rafael, CA 94901-3857 |
Second Address | San Rafael, CA 94901-3857 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2013 |
Last Update Date | 23/02/2015 |