Healthcare Provider Details

I. General information

NPI: 1356602817
Provider Name (Legal Business Name): LAUREN WYCOFF LPC, LMFT, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 RASOR BLVD STE 246
PLANO TX
75024-0341
US

IV. Provider business mailing address

8105 RASOR BLVD STE 246
PLANO TX
75024-0341
US

V. Phone/Fax

Practice location:
  • Phone: 281-460-6150
  • Fax:
Mailing address:
  • Phone: 281-460-6150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11706
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number77077
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: