Healthcare Provider Details

I. General information

NPI: 1316298417
Provider Name (Legal Business Name): JANE LOUISE LORENZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2484 N CALLE NOVENO
HUACHUCA CITY AZ
85616-0536
US

IV. Provider business mailing address

PO BOX 6253
HUACHUCA CITY AZ
85616-1353
US

V. Phone/Fax

Practice location:
  • Phone: 520-559-2377
  • Fax:
Mailing address:
  • Phone: 520-559-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-16461
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: