Healthcare Provider Details

I. General information

NPI: 1851839864
Provider Name (Legal Business Name): LAWRENCE SCANLON LMHC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 42ND ST
DES MOINES IA
50312
US

IV. Provider business mailing address

412 42ND ST
DES MOINES IA
50312-2814
US

V. Phone/Fax

Practice location:
  • Phone: 312-771-7722
  • Fax:
Mailing address:
  • Phone: 312-771-7722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number084957
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178008483
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: