Provider Demographics
NPI:1013276112
Name:VIRANT, LAUREN (MSSW, MFT-A)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:VIRANT
Suffix:
Gender:F
Credentials:MSSW, MFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 MARQUETTE DR.
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-1423
Mailing Address - Country:US
Mailing Address - Phone:502-724-4695
Mailing Address - Fax:
Practice Address - Street 1:4010 DUPONT CIR.
Practice Address - Street 2:STE. 582
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-6808
Practice Address - Country:US
Practice Address - Phone:502-899-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2013-039106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist