=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851697528
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN JOHNSON LPC-S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2011
-----------------------------------------------------
Last Update Date | 03/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 1/2 N MARKET ST
-----------------------------------------------------
City | BENTON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-727-1053
-----------------------------------------------------
Fax | 501-214-6867
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 208 E RICHARDSON PLACE DR
-----------------------------------------------------
City | BRYANT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72022-3246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-278-1736
-----------------------------------------------------
Fax | 501-214-6867
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | P1410080
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------