1629158712 NPI number — MRS. LORI ANN BESCUP LCSW

Table of content: MRS. LORI ANN BESCUP LCSW (NPI 1629158712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629158712 NPI number — MRS. LORI ANN BESCUP LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BESCUP
Provider First Name:
LORI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWISHER
Provider Other First Name:
LORI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629158712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
480 GALLETTI WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARKS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89431-5564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-688-2001
Provider Business Mailing Address Fax Number:
775-688-2192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
480 GALLETTI WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARKS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-688-2020
Provider Business Practice Location Address Fax Number:
775-688-2170
Provider Enumeration Date:
10/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  01755C , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)