MEDICARE: LAUREN ESWORTHY MA, LPC, LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	73863	TX
2	101YP2500X	Professional Counselor	E.2001992	OH

General Provider Information

NPI Number	:	1386090884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ESWORTHY MA, LPC, LPCC

Provider Business Mailing Address
First Line	:	3989 BROADWAY STE 305
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2639
Country	:	US
Telephone Number	:	614-594-3915
Fax Number	:	614-586-9149

Provider Business Practice Location Address
First Line	:	3989 BROADWAY STE 305
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2639
Country	:	US
Telephone Number	:	614-594-3915
Fax Number	:	614-586-9149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2016
Last Update Date	:	11/18/2020

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