MEDICARE: MRS. LORI LEE HORSTMEYER-GRUBB LMHC, BCPC

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	101YM0800X	Mental Health Counselor	39001483A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689679177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI LEE HORSTMEYER-GRUBB LMHC, BCPC

Provider Business Mailing Address
First Line	:	1816 CALIFORNIA AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5024
Country	:	US
Telephone Number	:	260-750-9678
Fax Number	:	260-387-7413

Provider Business Practice Location Address
First Line	:	1816 CALIFORNIA AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5024
Country	:	US
Telephone Number	:	260-750-9678
Fax Number	:	260-387-7413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	04/16/2014

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