Provider Demographics
NPI:1942639851
Name:LATHERS, LAUREN (LPC, CSAC, ICS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LATHERS
Suffix:
Gender:F
Credentials:LPC, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 N IRONWOOD RD STE 118
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4909
Mailing Address - Country:US
Mailing Address - Phone:414-253-7732
Mailing Address - Fax:414-206-3188
Practice Address - Street 1:5225 N IRONWOOD RD STE 118
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4909
Practice Address - Country:US
Practice Address - Phone:414-253-7732
Practice Address - Fax:414-206-3188
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)