Healthcare Provider Details

I. General information

NPI: 1619453263
Provider Name (Legal Business Name): LAUREN YEAREGO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN BROIHAN LLPC

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date: 10/19/2018
Reactivation Date: 06/10/2019

III. Provider practice location address

81 INDIANWOOD RD SUITE 2
LAKE ORION MI
48362
US

IV. Provider business mailing address

81 INDIANWOOD RD SUITE 2
LAKE ORION MI
48362
US

V. Phone/Fax

Practice location:
  • Phone: 586-651-1575
  • Fax:
Mailing address:
  • Phone: 248-303-3511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015919
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: