Provider Demographics
NPI:1073060414
Name:HARTJE-MAHAN, LORENE (MS)
Entity Type:Individual
Prefix:
First Name:LORENE
Middle Name:
Last Name:HARTJE-MAHAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 GOODING ST N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6178
Mailing Address - Country:US
Mailing Address - Phone:208-734-5230
Mailing Address - Fax:208-732-5894
Practice Address - Street 1:219 GOODING ST N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6178
Practice Address - Country:US
Practice Address - Phone:208-734-5230
Practice Address - Fax:208-732-5894
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)