Provider Demographics
NPI:1619453263
Name:YEAREGO, LAUREN (LPC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:YEAREGO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BROIHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLPC
Mailing Address - Street 1:81 INDIANWOOD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362
Mailing Address - Country:US
Mailing Address - Phone:248-303-3511
Mailing Address - Fax:
Practice Address - Street 1:81 INDIANWOOD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362
Practice Address - Country:US
Practice Address - Phone:586-651-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2020-12-31
Deactivation Date:2018-10-19
Deactivation Code:
Reactivation Date:2019-06-10
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MI6401015919101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor