Doctor Name: | MS. ELLIE T LORENZ |
NPI Number: | 1588815294 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | BA,CDP |
License Number: | CP00006154 |
Business Practice Address: | 2821 Mission Hill Rd Tulalip, WA - 982719706 |
Business Phone Number: | 3607164344 |
Business Fax Number: | |
Mailing Address: | Po Box 158, SOUTH CLE ELUM |
State: | WA |
Postal Code: | 989430158 |
Phone Number: | 5092600068 |
Fax Number: | |
NPI Enumeration Date: | 10/01/2008 |
NPI Last Update Date: | 10/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | CP00006154 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |