Provider Demographics
NPI:1306191796
Name:QUEEN, LAUREN DEIBEL (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:DEIBEL
Last Name:QUEEN
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 1:436 HARVEST HILL CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6269
Mailing Address - Country:US
Mailing Address - Phone:314-910-7601
Mailing Address - Fax:
Practice Address - Street 1:11166 TESSON FERRY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6966
Practice Address - Country:US
Practice Address - Phone:314-849-2120
Practice Address - Fax:314-729-1953
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2019-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008879101YP2500X
MO2010015161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional