MEDICARE: MRS. LORI RENEE VARGO CSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	L1532194	MI

General Provider Information

NPI Number	:	1447482393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI RENEE VARGO CSW

Provider Business Mailing Address
First Line	:	105 E FRONT ST
Second Line	:	SUITE 204
City	:	MONROE
State	:	MI
Zip	:	48161-2477
Country	:	US
Telephone Number	:	734-240-0372
Fax Number	:	734-481-0090

Provider Business Practice Location Address
First Line	:	105 E FRONT ST
Second Line	:	SUITE 204
City	:	MONROE
State	:	MI
Zip	:	48161-2477
Country	:	US
Telephone Number	:	734-240-0372
Fax Number	:	734-481-0090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2009
Last Update Date	:	08/11/2009

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