Provider Demographics
NPI:1255640041
Name:STOKES, LAUREN DRERUP (PHD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:DRERUP
Last Name:STOKES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 CALAIS CIR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2307
Mailing Address - Country:US
Mailing Address - Phone:318-442-7355
Mailing Address - Fax:318-442-4407
Practice Address - Street 1:1016 CALAIS CIR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2307
Practice Address - Country:US
Practice Address - Phone:318-442-7355
Practice Address - Fax:318-442-4407
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1288103TC0700X, 103TC2200X
LA321344103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1841281805OtherCENTER NPI