Provider Demographics
NPI:1588170237
Name:SULLIVAN, LAUREN NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N A W GRIMES BLVD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-3458
Mailing Address - Country:US
Mailing Address - Phone:214-608-9859
Mailing Address - Fax:
Practice Address - Street 1:1301 N A W GRIMES BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3458
Practice Address - Country:US
Practice Address - Phone:214-608-9859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health