Provider Demographics
NPI:1285946772
Name:CHURCHILL, LAUREN MARIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5341
Mailing Address - Country:US
Mailing Address - Phone:610-248-5190
Mailing Address - Fax:
Practice Address - Street 1:1005 BROOKSIDE RD
Practice Address - Street 2:SUITE 330
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9023
Practice Address - Country:US
Practice Address - Phone:610-248-5190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional