Healthcare Provider Details

I. General information

NPI: 1154668556
Provider Name (Legal Business Name): LORRAINE KAY MARSHALL LMSW, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 HOSPITAL LOOP
OWYHEE NV
89832-0130
US

IV. Provider business mailing address

PO BOX 130 1623 HOSPITAL LOOP
OWYHEE NV
89832-0130
US

V. Phone/Fax

Practice location:
  • Phone: 775-757-2415
  • Fax: 775-757-3010
Mailing address:
  • Phone: 775-757-2415
  • Fax: 775-757-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: