Healthcare Provider Details

I. General information

NPI: 1689482069
Provider Name (Legal Business Name): LAUREN KOFRON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6744 CLAYTON RD STE 221
SAINT LOUIS MO
63117-1634
US

IV. Provider business mailing address

812 MANITOU DR
SAINT LOUIS MO
63119-1230
US

V. Phone/Fax

Practice location:
  • Phone: 314-720-2710
  • Fax:
Mailing address:
  • Phone: 314-791-4103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2022032266
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: