Basic Information
| Provider Information | |||||||||
| NPI: | 1073709234 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIVAN | ||||||||
| FirstName: | LAUREN | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5515 ROBERT CT | ||||||||
| Address2: | |||||||||
| City: | NORTH RIDGEVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440391777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405086105 | ||||||||
| FaxNumber: | 4402608305 | ||||||||
| Practice Location | |||||||||
| Address1: | 16101 SNOW RD | ||||||||
| Address2: | |||||||||
| City: | BROOKPARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441422817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402608327 | ||||||||
| FaxNumber: | 4402608305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2007 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801093886 | MI | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | I.1501255 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.