Provider Demographics
NPI:1477109189
Name:FLAHERTY, LAUREN BROOKE (TLLP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:BROOKE
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8007 LYNDON CENTRE WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3608
Mailing Address - Country:US
Mailing Address - Phone:502-690-8024
Mailing Address - Fax:
Practice Address - Street 1:8007 LYNDON CENTRE WAY STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3608
Practice Address - Country:US
Practice Address - Phone:502-690-8024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-18
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY284414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical