Provider Demographics
NPI:1043963747
Name:SKILTON, LAUREN ANN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:SKILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 STARR AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:248-308-7816
Mailing Address - Fax:
Practice Address - Street 1:250 STARR AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-308-7816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2023-02-09
Deactivation Date:2023-01-30
Deactivation Code:
Reactivation Date:2023-02-07
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MI6451022750101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health