Healthcare Provider Details

I. General information

NPI: 1386090884
Provider Name (Legal Business Name): LAUREN ESWORTHY MA, LPC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3989 BROADWAY STE 305
GROVE CITY OH
43123-2639
US

IV. Provider business mailing address

3989 BROADWAY STE 305
GROVE CITY OH
43123-2639
US

V. Phone/Fax

Practice location:
  • Phone: 614-594-3915
  • Fax: 614-586-9149
Mailing address:
  • Phone: 614-594-3915
  • Fax: 614-586-9149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number73863
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2001992
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: