Provider Demographics
NPI:1487917183
Name:MITCHELL, LAUREN SCOGGINS (LCSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:SCOGGINS
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 N 2ND ST 1
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601
Mailing Address - Country:US
Mailing Address - Phone:325-518-1370
Mailing Address - Fax:325-480-1112
Practice Address - Street 1:1140 N 2ND ST 1
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601
Practice Address - Country:US
Practice Address - Phone:325-518-1370
Practice Address - Fax:325-480-1112
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX536361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2971491Medicaid
272943Medicare UPIN