Healthcare Provider Details

I. General information

NPI: 1902280936
Provider Name (Legal Business Name): LAUREN FRANCES THOMAS LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN STUEDLE LMHA

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 W WHITE RIVER BLVD
MUNCIE IN
47304-4286
US

IV. Provider business mailing address

240 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

V. Phone/Fax

Practice location:
  • Phone: 765-288-1928
  • Fax: 765-288-2032
Mailing address:
  • Phone: 765-288-1928
  • Fax: 765-741-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number88000216A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: