Healthcare Provider Details

I. General information

NPI: 1760229520
Provider Name (Legal Business Name): KENNETH S LORENZ MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N WILLIAMS ST UNIT C
MOBERLY MO
65270-1583
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 660-263-7651
  • Fax:
Mailing address:
  • Phone: 417-761-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2018043710
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: