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NPI Code Detail

MEDICARE: LAUREN GROUSD LCPC PLLC

MEDICARE: LAUREN GROUSD LCPC PLLC
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
1101YP2500XProfessional CounselorCC4380ME

General Provider Information

NPI Number : 1043763097
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAUREN GROUSD LCPC PLLC
Provider Business Mailing Address
First Line : 440 FOREST AVE
Second Line :
City : PORTLAND
State : ME
Zip : 04101-2015
Country : US
Telephone Number : 207-650-8906
Fax Number : 207-221-2130
Provider Business Practice Location Address
First Line : 440 FOREST AVE
Second Line :
City : PORTLAND
State : ME
Zip : 04101-2015
Country : US
Telephone Number : 207-650-8906
Fax Number : 207-221-2130
Authorized Official
Title or Position : OWNER
Name : MS. LAUREN ELIZABETH GROUSD
Credential : LCPC
Telephone Number : 207-650-8906
Provider Enumeration Date : 07/26/2016
Last Update Date : 07/26/2016

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Directions to “LAUREN GROUSD LCPC PLLC ” Practice Location

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