Provider Demographics
NPI:1740062066
Name:CALLIS, LAUREN (LPCC, ATR)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CALLIS
Suffix:
Gender:F
Credentials:LPCC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2148
Mailing Address - Country:US
Mailing Address - Phone:605-595-2014
Mailing Address - Fax:
Practice Address - Street 1:6550 YORK AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2347
Practice Address - Country:US
Practice Address - Phone:952-426-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03173221700000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist