Healthcare Provider Details

I. General information

NPI: 1568432904
Provider Name (Legal Business Name): LORING FAMILY THERAPY SERICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 OAK GROVE ST STE 414
MINNEAPOLIS MN
55403-3242
US

IV. Provider business mailing address

430 OAK GROVE ST STE 414
MINNEAPOLIS MN
55403-3242
US

V. Phone/Fax

Practice location:
  • Phone: 612-872-9072
  • Fax: 612-872-5605
Mailing address:
  • Phone: 612-872-9072
  • Fax: 612-872-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP1794
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP1733
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT1146
License Number StateMN

VIII. Authorized Official

Name: DR. GARY GENE JOHNSON
Title or Position: DIRECTOR PRESIDENT
Credential: PHD LP LMFT
Phone: 612-872-9072