MEDICARE: LAUREN SELF COUNSELING LLC

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

General Provider Information

NPI Number	:	1578109922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREN SELF COUNSELING LLC

Provider Business Mailing Address
First Line	:	103 BEAU TERRA LN
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35811-8090
Country	:	US
Telephone Number	:	256-604-0836
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 MADISON ST SE
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-4401
Country	:	US
Telephone Number	:	256-644-4005
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MRS. LAUREN SELF
Credential	:	LPC
Telephone Number	:	256-644-4005

Provider Enumeration Date	:	11/20/2019
Last Update Date	:	11/20/2019

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