MEDICARE: LAUREN FERNS CT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C.2405565-TRNE	OH

General Provider Information

NPI Number	:	1033973581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN FERNS CT

Provider Business Mailing Address
First Line	:	1397 WARREN RD UNIT 5
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2570
Country	:	US
Telephone Number	:	216-202-4286
Fax Number	:

Provider Business Practice Location Address
First Line	:	1397 WARREN RD UNIT 5
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2570
Country	:	US
Telephone Number	:	216-202-4286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	02/06/2024

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Directions to “ LAUREN FERNS CT” Practice Location

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