Provider Demographics
NPI:1164761094
Name:WHITE, LAUREN ALEXIS (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ALEXIS
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 CONCOURSE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-8672
Mailing Address - Country:US
Mailing Address - Phone:734-230-2796
Mailing Address - Fax:
Practice Address - Street 1:4343 CONCOURSE DR STE 150
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-8672
Practice Address - Country:US
Practice Address - Phone:734-230-2796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013496101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E80358OtherBCBS
MI38-1810060Medicaid