Individual
LAUREN LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15489 DEDEAUX RD, GULFPORT, MS 39503-2667
(228) 357-5671
Mailing address
15489 DEDEAUX RD, GULFPORT, MS 39503-2667
(228) 357-5671
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
19-103765
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
802488417
MS DRIVERS LICENSE
MS
Enumeration date
07/23/2020
Last updated
07/23/2020
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