Provider Demographics
NPI:1063501146
Name:LEBAHN, LORI R (MS LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:R
Last Name:LEBAHN
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10263
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72812-0263
Mailing Address - Country:US
Mailing Address - Phone:479-280-1962
Mailing Address - Fax:479-567-5521
Practice Address - Street 1:1110 W B ST
Practice Address - Street 2:SUITE K
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3506
Practice Address - Country:US
Practice Address - Phone:479-280-1962
Practice Address - Fax:479-567-5521
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9810027101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health