Provider Demographics
NPI:1073529350
Name:LOMMEN, ORVIN G (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ORVIN
Middle Name:G
Last Name:LOMMEN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#9 CORTLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703
Mailing Address - Country:US
Mailing Address - Phone:701-240-7944
Mailing Address - Fax:701-857-8555
Practice Address - Street 1:#9 CORTLAND DRIVE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703
Practice Address - Country:US
Practice Address - Phone:701-240-7944
Practice Address - Fax:701-857-8555
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
05358OtherBCBS
ND054517Medicaid
ND019220Medicaid
ND$$$$$$$$$OtherCHAMPUS
ND$$$$$$$$$OtherCHAMPUS VA
ND054517Medicaid