Provider Demographics
NPI:1922640481
Name:GANDY, LAUREN (LPC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GANDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6704
Mailing Address - Country:US
Mailing Address - Phone:903-212-7800
Mailing Address - Fax:903-212-7899
Practice Address - Street 1:4519 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2350
Practice Address - Country:US
Practice Address - Phone:903-289-9252
Practice Address - Fax:903-630-5456
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77333101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional