Provider Demographics
NPI:1003074394
Name:ANDERSON, LORRE ROYANNE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:LORRE
Middle Name:ROYANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:LORRE
Other - Middle Name:ROYANNE
Other - Last Name:BRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4025 S MCCLINTOCK DR # 212
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-278-9024
Mailing Address - Fax:
Practice Address - Street 1:4025 S MCCLINTOCK DR # 212
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-278-9024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-2117101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional