Provider Demographics
NPI:1073193181
Name:BUROKER, LAUREN (LMFT, MED/EDS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BUROKER
Suffix:
Gender:F
Credentials:LMFT, MED/EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10702 PRESERVE LAKE DR APT 109
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4438
Mailing Address - Country:US
Mailing Address - Phone:727-515-2919
Mailing Address - Fax:
Practice Address - Street 1:6911 PISTOL RANGE RD STE 104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-6335
Practice Address - Country:US
Practice Address - Phone:813-321-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist