Provider Demographics
NPI:1083363162
Name:STREY, LORA
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:STREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24893 NORWAY PINE PL
Mailing Address - Street 2:
Mailing Address - City:EMILY
Mailing Address - State:MN
Mailing Address - Zip Code:56447-5019
Mailing Address - Country:US
Mailing Address - Phone:612-712-6208
Mailing Address - Fax:612-249-0078
Practice Address - Street 1:730 E 38TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-5217
Practice Address - Country:US
Practice Address - Phone:612-712-6208
Practice Address - Fax:612-249-0078
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist