Provider Demographics
NPI:1548009822
Name:MANGRUM, LAUREN NICOLETTE (LMHC, MA, NCC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLETTE
Last Name:MANGRUM
Suffix:
Gender:F
Credentials:LMHC, MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W SYBELIA AVE
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4739
Mailing Address - Country:US
Mailing Address - Phone:407-865-0495
Mailing Address - Fax:407-543-8351
Practice Address - Street 1:152 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4133
Practice Address - Country:US
Practice Address - Phone:407-865-0495
Practice Address - Fax:407-543-8351
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23800101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health