Provider Demographics
NPI:1265684203
Name:RUTHVEN, LAUREN JOHNSON (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:JOHNSON
Last Name:RUTHVEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18521 CANTRELL ROAD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223
Mailing Address - Country:US
Mailing Address - Phone:501-559-3150
Mailing Address - Fax:501-307-1081
Practice Address - Street 1:1 MAYWOOD DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-9735
Practice Address - Country:US
Practice Address - Phone:501-559-3150
Practice Address - Fax:501-307-1081
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2596-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V971Medicare PIN