Basic Information
| Provider Information | |||||||||
| NPI: | 1063586402 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LORELEI | ||||||||
| FirstName: | MADELEINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSYD, LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LORELEI | ||||||||
| OtherFirstName: | MADELEINE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | PSYD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 785 TUCKER RD | ||||||||
| Address2: | SUITE G-PMB # 586 | ||||||||
| City: | TEHACHAPI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935612523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616099649 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2525 N CHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933081770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6616099649 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2006 | ||||||||
| LastUpdateDate: | 02/16/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TA0400X | PSY24885 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TA0700X | PSY24885 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103TB0200X | PSY24885 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC1900X | PSY24885 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TC2200X | PSY24885 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TF0000X | PSY24885 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Family | 103TP2701X | PSY24885 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 106H00000X | MFC41411 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 103TC0700X | PSY24885 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.