Provider Demographics
NPI:1689970675
Name:LAUREN, ELISSABETH AMANDA (LPCC)
Entity Type:Individual
Prefix:
First Name:ELISSABETH
Middle Name:AMANDA
Last Name:LAUREN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2102
Mailing Address - Country:US
Mailing Address - Phone:952-361-1640
Mailing Address - Fax:952-361-1660
Practice Address - Street 1:600 E 4TH ST
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2102
Practice Address - Country:US
Practice Address - Phone:952-361-1640
Practice Address - Fax:952-361-1660
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional