Basic Information
| Provider Information | |||||||||
| NPI: | 1588631451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PASSARELLO | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 262 CHEROKEE PROFESSIONAL PARK | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378045153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659844223 | ||||||||
| FaxNumber: | 8656811789 | ||||||||
| Practice Location | |||||||||
| Address1: | 262 CHEROKEE PROFESSIONAL PARK | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378045153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659844223 | ||||||||
| FaxNumber: | 8656811789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 02/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMT0000000524 | TN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | LMT0000000524 | 01 | TN | LICENSE | OTHER |