Healthcare Provider Details

I. General information

NPI: 1801121652
Provider Name (Legal Business Name): STEPHANIE MICHELLE LORANCE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 S BEARFIELD RD
COLUMBIA MO
65201-9557
US

IV. Provider business mailing address

4104 COTTON WOOD DR
COLUMBIA MO
65202-4906
US

V. Phone/Fax

Practice location:
  • Phone: 573-874-8686
  • Fax:
Mailing address:
  • Phone: 573-268-2769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011018274
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: