Provider Demographics
NPI:1619574407
Name:OBERG, LAUREN (LMSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:OBERG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:MAYOTTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:1724 BLAIR ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-1101
Mailing Address - Country:US
Mailing Address - Phone:517-643-7492
Mailing Address - Fax:
Practice Address - Street 1:1724 BLAIR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-1101
Practice Address - Country:US
Practice Address - Phone:517-618-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011084351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical