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General NPI Number Information
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NPI Number | 1831459106
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Entity Type | Individual
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Provider Name | TARA MCRAE LORENZ LICSW
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Gender | Female
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1500 14TH ST W STE 290
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City | WILLISTON
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State | ND
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Zip | 58801-4078
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Country | US
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Telephone | 701-334-6242
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Fax |
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Provider Business Mailing Address
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Address Line | 307 LAKE ST
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City | NEW SALEM
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State | ND
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Zip | 58563-4101
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Country | US
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Telephone | 707-530-5098
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW62900
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LICSW5476
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License Number State | ND
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