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General NPI Number Information
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NPI Number | 1063501146
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Entity Type | Individual
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Provider Name | LORI R LEBAHN MS LPC
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 1110 W B ST SUITE K
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-3506
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Country | US
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Telephone | 479-280-1962
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Fax | 479-567-5521
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Provider Business Mailing Address
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Address Line | PO BOX 10263
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City | RUSSELLVILLE
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State | AR
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Zip | 72812-0263
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Country | US
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Telephone | 479-280-1962
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Fax | 479-567-5521
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P9810027
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License Number State | AR
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