Provider Demographics
NPI:1255992111
Name:LA PLANTE, LAUREN AMANDA (LEP, PPSC, NCSP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:AMANDA
Last Name:LA PLANTE
Suffix:
Gender:F
Credentials:LEP, PPSC, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2477
Mailing Address - Country:US
Mailing Address - Phone:510-703-1027
Mailing Address - Fax:
Practice Address - Street 1:2501 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2477
Practice Address - Country:US
Practice Address - Phone:510-703-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2935103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2935OtherLEP