MEDICARE: DR. LORI NABORS PSYCHOTHERAPY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1306700612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. LORI NABORS PSYCHOTHERAPY, PLLC

Provider Business Mailing Address
First Line	:	2601 WEST LAKE AVENUE
Second Line	:	SUITE A-6, #243
City	:	PEORIA
State	:	IL
Zip	:	61615
Country	:	US
Telephone Number	:	815-310-5881
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 W LAKE AVE STE 6A
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-3777
Country	:	US
Telephone Number	:	815-310-5881
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. LORI MICHELLE NABORS
Credential	:	PSYD
Telephone Number	:	815-310-5881

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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