Healthcare Provider Details

I. General information

NPI: 1285817361
Provider Name (Legal Business Name): DENISE LORENZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 SOUTH ELM ST
DIXON MO
65459-6004
US

IV. Provider business mailing address

405 S SHILOH AVE
CONWAY MO
65632-8209
US

V. Phone/Fax

Practice location:
  • Phone: 573-433-4181
  • Fax:
Mailing address:
  • Phone: 573-433-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2007035738
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: