Healthcare Provider Details

I. General information

NPI: 1700459062
Provider Name (Legal Business Name): LAUREN LANSRUD LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9777 TRANQUILITY LAKE CIR APT 403
RIVERVIEW FL
33578-4053
US

IV. Provider business mailing address

9777 TRANQUILITY LAKE CIR APT 403
RIVERVIEW FL
33578-4053
US

V. Phone/Fax

Practice location:
  • Phone: 813-825-6911
  • Fax:
Mailing address:
  • Phone: 813-825-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0135048TELE
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13185741-6004
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberMH19386
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: