Healthcare Provider Details

I. General information

NPI: 1356591275
Provider Name (Legal Business Name): LAUREN AMANDA CARSTEN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2008
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11369 MARKET ST
NORTH LIMA OH
44452-9782
US

IV. Provider business mailing address

246 NORTHLAND DR
MEDINA OH
44256-3441
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9999
  • Fax: 330-757-0000
Mailing address:
  • Phone: 330-725-9195
  • Fax: 330-725-9187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: