Healthcare Provider Details

I. General information

NPI: 1962097659
Provider Name (Legal Business Name): LAUREN HAGGART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4081 CASCADE RD SE STE 500
GRAND RAPIDS MI
49546-2154
US

IV. Provider business mailing address

4081 CASCADE RD SE STE 500
GRAND RAPIDS MI
49546-2154
US

V. Phone/Fax

Practice location:
  • Phone: 616-500-8922
  • Fax:
Mailing address:
  • Phone: 616-500-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024572
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: