Provider Demographics
NPI:1972271781
Name:TISON, LAUREN MILLER (LPC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MILLER
Last Name:TISON
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 1:3025 ANSLEY ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-3834
Mailing Address - Country:US
Mailing Address - Phone:407-312-1085
Mailing Address - Fax:
Practice Address - Street 1:514 W MAPLE ST STE 406
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-3093
Practice Address - Country:US
Practice Address - Phone:469-525-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health