Healthcare Provider Details

I. General information

NPI: 1306767801
Provider Name (Legal Business Name): LR THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S 5TH ST
GOSHEN IN
46528-3711
US

IV. Provider business mailing address

64542 COUNTY ROAD 21
GOSHEN IN
46526-9106
US

V. Phone/Fax

Practice location:
  • Phone: 574-849-8577
  • Fax:
Mailing address:
  • Phone: 574-849-8577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LORA RUSEL
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 574-849-8577