Provider Demographics
NPI:1043789928
Name:STRYKER, LORA HALE (LCSW)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:HALE
Last Name:STRYKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N W C OWEN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-2811
Mailing Address - Country:US
Mailing Address - Phone:954-242-1670
Mailing Address - Fax:
Practice Address - Street 1:1100 S OLYMPIA ST
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-4400
Practice Address - Country:US
Practice Address - Phone:863-302-6022
Practice Address - Fax:863-265-6018
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL155531101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health