Provider Demographics
NPI:1104684265
Name:GROGMAN, LAUREN (MS, LPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GROGMAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6138 ANITA ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2611
Mailing Address - Country:US
Mailing Address - Phone:214-289-4285
Mailing Address - Fax:
Practice Address - Street 1:11300 N CENTRAL EXPY STE 402
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6712
Practice Address - Country:US
Practice Address - Phone:214-289-4285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73771101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional