Provider Demographics
NPI:1700459062
Name:LANSRUD, LAUREN (LMHC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LANSRUD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9777 TRANQUILITY LAKE CIR APT 403
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4053
Mailing Address - Country:US
Mailing Address - Phone:813-825-6911
Mailing Address - Fax:
Practice Address - Street 1:9777 TRANQUILITY LAKE CIR APT 403
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4053
Practice Address - Country:US
Practice Address - Phone:813-825-6911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135048TELE101YM0800X
UT13185741-6004101YM0800X
FLMH19386222Q00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist