MEDICARE: LAUREN BRUYERE

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	12153-125	WI
2	101YP2500X	Professional Counselor	5335	MN

General Provider Information

NPI Number	:	1821952359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN BRUYERE

Provider Business Mailing Address
First Line	:	2025 4TH ST STE 100
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-2875
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2025 4TH ST STE 100
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-2875
Country	:	US
Telephone Number	:	651-212-4920
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ LAUREN BRUYERE ” Practice Location

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