=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710498951
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN ELISE ROEBUCK LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2017
-----------------------------------------------------
Last Update Date | 04/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 177 W EXCHANGE ST
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44302-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-543-7475
-----------------------------------------------------
Fax | 330-543-5276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 177 W EXCHANGE ST
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44302-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-543-7475
-----------------------------------------------------
Fax | 330-543-5276
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | E.2404184
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | C.1800876
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------