MEDICARE: LORING FAMILY THERAPY SERICES INC

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	103T00000X	Psychologist	LP1794	MN
2	103T00000X	Psychologist	LP1733	MN
3	106H00000X	Marriage & Family Therapist	LMFT1146	MN

General Provider Information

NPI Number	:	1568432904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORING FAMILY THERAPY SERICES INC

Provider Business Mailing Address
First Line	:	430 OAK GROVE ST
Second Line	:	STE 414
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3242
Country	:	US
Telephone Number	:	612-872-9072
Fax Number	:	612-872-5605

Provider Business Practice Location Address
First Line	:	430 OAK GROVE ST
Second Line	:	STE 414
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3242
Country	:	US
Telephone Number	:	612-872-9072
Fax Number	:	612-872-5605

Authorized Official
Title or Position	:	DIRECTOR PRESIDENT
Name	:	DR. GARY GENE JOHNSON
Credential	:	PHD LP LMFT
Telephone Number	:	612-872-9072

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	09/11/2025

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