1134366040 NPI number — MISS MICHELE MARIE LORENZ MSW, LCSW

Table of content: MR. STEPHEN HAYNES CARLSON PSYD (NPI 1174758569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134366040 NPI number — MISS MICHELE MARIE LORENZ MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LORENZ
Provider First Name:
MICHELE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134366040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 WARNER AVE.
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-274-9573
Provider Business Mailing Address Fax Number:
714-274-9654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5200 WARNER AVE.
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-274-9573
Provider Business Practice Location Address Fax Number:
714-274-9654
Provider Enumeration Date:
01/14/2009

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:  005000 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCS28392 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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