Provider Demographics
NPI:1982057717
Name:HERLINE, LAUREN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:HERLINE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2791
Mailing Address - Country:US
Mailing Address - Phone:989-486-3021
Mailing Address - Fax:
Practice Address - Street 1:104 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2791
Practice Address - Country:US
Practice Address - Phone:989-486-3021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-17
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017142103TC0700X
247200000X
MI6351004645103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other