Healthcare Provider Details

I. General information

NPI: 1902544521
Provider Name (Legal Business Name): THE MENTAL HEALTH LAB, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 6TH AVE
GRINNELL IA
50112-1958
US

IV. Provider business mailing address

515 6TH AVE
GRINNELL IA
50112-1958
US

V. Phone/Fax

Practice location:
  • Phone: 641-990-4936
  • Fax: 866-517-2361
Mailing address:
  • Phone: 641-990-4936
  • Fax: 866-517-2361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LORI HALVORSON
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 641-990-4936