Provider Demographics
NPI:1174911176
Name:GASTORF, LAUREN (LPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GASTORF
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 1:6675 MEDITERRANEAN DR
Mailing Address - Street 2:SUITE #506
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5573
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6675 MEDITERRANEAN DR
Practice Address - Street 2:SUITE #506
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5573
Practice Address - Country:US
Practice Address - Phone:972-841-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2015-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX473736898OtherTIN
TX46-083-4342OtherEIN