Provider Demographics
NPI:1487406948
Name:GOSS, LAUREN RAE (REGISTERED INTERN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:RAE
Last Name:GOSS
Suffix:
Gender:F
Credentials:REGISTERED INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 N GOLDENROD RD APT D
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9044
Mailing Address - Country:US
Mailing Address - Phone:406-435-2262
Mailing Address - Fax:
Practice Address - Street 1:3993 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9726
Practice Address - Country:US
Practice Address - Phone:407-732-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT4116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health