Provider Demographics
NPI:1497158547
Name:MCGILL, LAUREN ANN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ANN
Last Name:MCGILL
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 1:214 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6223
Mailing Address - Country:US
Mailing Address - Phone:570-455-1521
Mailing Address - Fax:570-455-2707
Practice Address - Street 1:214 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6223
Practice Address - Country:US
Practice Address - Phone:570-455-1521
Practice Address - Fax:570-455-2707
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000801106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist