MEDICARE: LORRAINE SELLNER LPCC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1922776103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRAINE SELLNER LPCC

Provider Business Mailing Address
First Line	:	11985 MAPLEWOOD RIDGE CT
Second Line	:
City	:	EAST GULL LAKE
State	:	MN
Zip	:	56401-7501
Country	:	US
Telephone Number	:	218-330-7431
Fax Number	:

Provider Business Practice Location Address
First Line	:	11985 MAPLEWOOD RIDGE CT
Second Line	:
City	:	EAST GULL LAKE
State	:	MN
Zip	:	56401-7501
Country	:	US
Telephone Number	:	218-855-8767
Fax Number	:

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

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	09/01/2021

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