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General NPI Number Information
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NPI Number | 1528148087
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Entity Type | Organization
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Legal Business Name | LOREN E. NOVAK & ASSOCIATES, INC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 821 3RD ST SUITE 100
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City | FARMINGTON
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State | MN
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Zip | 55024-1558
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Country | US
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Telephone | 651-460-8085
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Fax | 651-463-8816
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Provider Business Mailing Address
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Address Line | 16511 ANNA TRL SE SUITE C
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City | PRIOR LAKE
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State | MN
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Zip | 55372-4533
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Country | US
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Telephone | 952-447-1117
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Fax | 952-447-1116
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. WILLIAM M. WALBERG
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Credential | LADC
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Telephone | 952-447-1117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 830960-1
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License Number State | MN
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