Provider Demographics
NPI:1194212118
Name:BALDWIN, LAUREN MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 CHATHAM RD STE N
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4188
Mailing Address - Country:US
Mailing Address - Phone:773-616-0657
Mailing Address - Fax:
Practice Address - Street 1:2501 CHATHAM RD STE N
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4188
Practice Address - Country:US
Practice Address - Phone:773-616-0657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2023-11-27
Deactivation Date:2020-10-05
Deactivation Code:
Reactivation Date:2023-11-21
Provider Licenses
StateLicense IDTaxonomies
IL166001460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist