Provider Demographics
NPI:1043763097
Name:LAUREN GROUSD LCPC PLLC
Entity Type:Organization
Organization Name:LAUREN GROUSD LCPC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GROUSD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-650-8906
Mailing Address - Street 1:440 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2015
Mailing Address - Country:US
Mailing Address - Phone:207-650-8906
Mailing Address - Fax:207-221-2130
Practice Address - Street 1:440 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2015
Practice Address - Country:US
Practice Address - Phone:207-650-8906
Practice Address - Fax:207-221-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty