Basic Information
| Provider Information | |||||||||
| NPI: | 1265705875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPC, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 DEVILLE LN # PVT | ||||||||
| Address2: | METHODIST CHILDREN'S HOME FAMILY COUNSEILING CENTER | ||||||||
| City: | RUSTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712706313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182424644 | ||||||||
| FaxNumber: | 3182424698 | ||||||||
| Practice Location | |||||||||
| Address1: | 902 DEVILLE LN # PVT | ||||||||
| Address2: | METHODIST CHILDREN'S HOME FAMILY COUNSEILING CENTER | ||||||||
| City: | RUSTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712706313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182424644 | ||||||||
| FaxNumber: | 3182424698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2012 | ||||||||
| LastUpdateDate: | 02/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2934 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 956 | LA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.