Provider Demographics
NPI:1821564493
Name:WOLF, LAUREN LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEE
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 BOARDMAN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-8826
Mailing Address - Country:US
Mailing Address - Phone:231-342-5611
Mailing Address - Fax:
Practice Address - Street 1:6051 FRANKFORT HWY STE 100
Practice Address - Street 2:
Practice Address - City:BENZONIA
Practice Address - State:MI
Practice Address - Zip Code:49616-9657
Practice Address - Country:US
Practice Address - Phone:231-882-4409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011033021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical