Provider Demographics
NPI:1003682139
Name:MCLAUGHLIN, LAUREN ANN (TLLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24719 KINSEL ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2939
Mailing Address - Country:US
Mailing Address - Phone:843-834-9808
Mailing Address - Fax:
Practice Address - Street 1:24719 KINSEL ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2939
Practice Address - Country:US
Practice Address - Phone:843-834-9808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009863103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist