Provider Demographics
NPI:1659580900
Name:LONGWELL, LAUREN LEA (MA LPC LBSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEA
Last Name:LONGWELL
Suffix:
Gender:F
Credentials:MA LPC LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 PORTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093
Mailing Address - Country:US
Mailing Address - Phone:269-273-7562
Mailing Address - Fax:
Practice Address - Street 1:1020 MILLARD STREET
Practice Address - Street 2:COMMUNITY HEALING CENTERS
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093
Practice Address - Country:US
Practice Address - Phone:269-279-5187
Practice Address - Fax:269-273-2083
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005632101Y00000X
MI6802063317101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor