Basic Information
Provider Information | |||||||||
NPI: | 1558847012 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CORRELL | ||||||||
FirstName: | LAUREN ALEXIS | ||||||||
MiddleName: | RACHEL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSY.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CORRELL | ||||||||
OtherFirstName: | LAUREN | ||||||||
OtherMiddleName: | RACHEL | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1 VISTA MONTANA APT 4306 | ||||||||
Address2: |   | ||||||||
City: | SAN JOSE | ||||||||
State: | CA | ||||||||
PostalCode: | 951342734 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2157761761 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3801 MIRANDA AVE | ||||||||
Address2: | PSYCHOLOGY SERVICE (116B) | ||||||||
City: | PALO ALTO | ||||||||
State: | CA | ||||||||
PostalCode: | 94304 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6504935000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2018 | ||||||||
LastUpdateDate: | 07/17/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TH0004X |   |   | Y |   | Behavioral Health & Social Service Providers | Psychologist | Health |
No ID Information.