Provider Demographics
NPI:1265318570
Name:MEJIA, LAUREN NOELLE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NOELLE
Last Name:MEJIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11542 MIDDLE FORK WAY
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-3214
Mailing Address - Country:US
Mailing Address - Phone:909-536-4374
Mailing Address - Fax:
Practice Address - Street 1:11983 TAMIAMI TRL N # 121
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1603
Practice Address - Country:US
Practice Address - Phone:800-875-1871
Practice Address - Fax:800-875-1871
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1371028106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician