Healthcare Provider Details

I. General information

NPI: 1447770128
Provider Name (Legal Business Name): LAUREN BENNETT LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 LINWOOD DR STE B
PARAGOULD AR
72450-5365
US

IV. Provider business mailing address

1707 LINWOOD DR STE B
PARAGOULD AR
72450-5365
US

V. Phone/Fax

Practice location:
  • Phone: 870-604-4455
  • Fax: 888-977-2956
Mailing address:
  • Phone:
  • Fax: 888-977-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2410009
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: