=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851575807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI JEAN VINSON LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2007
-----------------------------------------------------
Last Update Date | 04/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1814 US HIGHWAY 79 S
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75654-4502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-657-9717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 E MAIN ST
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75652-3201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-657-9717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 60715
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------