Provider Demographics
NPI:1700459062
Name:LANSRUD, LAUREN (LMHC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LANSRUD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6016 N FLORA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-6814
Mailing Address - Country:US
Mailing Address - Phone:813-817-8788
Mailing Address - Fax:
Practice Address - Street 1:6016 N FLORA VISTA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-6814
Practice Address - Country:US
Practice Address - Phone:813-817-8788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19386222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist