Provider Demographics
NPI:1154793099
Name:CRANDALL, LAUREN NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:CRANDALL
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 1:9076 SOUTHERN CHARM DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-3643
Mailing Address - Country:US
Mailing Address - Phone:805-990-8441
Mailing Address - Fax:
Practice Address - Street 1:9076 SOUTHERN CHARM DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-3643
Practice Address - Country:US
Practice Address - Phone:805-990-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5735101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional