Healthcare Provider Details

I. General information

NPI: 1275471633
Provider Name (Legal Business Name): LORIN PUEBLA MS, ALC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 COURTHOUSE SQ
BAY MINETTE AL
36507-4812
US

IV. Provider business mailing address

1304 MARKS AVE
BAY MINETTE AL
36507-5117
US

V. Phone/Fax

Practice location:
  • Phone: 251-716-2170
  • Fax:
Mailing address:
  • Phone: 251-716-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC05059
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: