Healthcare Provider Details

I. General information

NPI: 1427724699
Provider Name (Legal Business Name): LAUREN ASHLEY DUSHANE MA, MLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N PERRY ST
PONTIAC MI
48342-2217
US

IV. Provider business mailing address

50 N PERRY ST
PONTIAC MI
48342-2217
US

V. Phone/Fax

Practice location:
  • Phone: 248-338-5000
  • Fax:
Mailing address:
  • Phone: 248-338-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number25203050752
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362009358
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: