Healthcare Provider Details

I. General information

NPI: 1952702425
Provider Name (Legal Business Name): LAUREN BETH SHIBLEY-LEGAULT LMHC-A, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 PUTNAM PIKE STE 1
JOHNSTON RI
02919-7516
US

IV. Provider business mailing address

21 ARTHUR ST
WEST WARWICK RI
02893-5139
US

V. Phone/Fax

Practice location:
  • Phone: 401-773-7116
  • Fax:
Mailing address:
  • Phone: 401-632-6801
  • Fax:

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: