Healthcare Provider Details

I. General information

NPI: 1790200855
Provider Name (Legal Business Name): LAUREN HENNEMANN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN GUFFEY

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COMMUNITY
CLINTON MO
64735-8804
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 660-890-8183
  • Fax:
Mailing address:
  • Phone: 660-890-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2017028454
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: