MEDICARE: DR. CHAD THOMAS LORENZ PSY.D., MBA

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	103TF0000X	Family Psychologist	LP 5754	MN
2	106H00000X	Marriage & Family Therapist	1764	MN

General Provider Information

NPI Number	:	1629213541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD THOMAS LORENZ PSY.D., MBA

Provider Business Mailing Address
First Line	:	PO BOX 51
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386
Country	:	US
Telephone Number	:	952-443-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1772 STEIGER LAKE LN STE 220
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-7723
Country	:	US
Telephone Number	:	952-443-4600
Fax Number	:	952-443-4604

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

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	05/23/2016

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