Provider Demographics
NPI:1689482069
Name:KOFRON, LAUREN (LPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KOFRON
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 1:812 MANITOU DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1230
Mailing Address - Country:US
Mailing Address - Phone:314-791-4103
Mailing Address - Fax:
Practice Address - Street 1:6744 CLAYTON RD STE 221
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1634
Practice Address - Country:US
Practice Address - Phone:314-720-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022032266101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty