Provider Demographics
NPI:1104030048
Name:LAURIDSEN, LORI I (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:I
Last Name:LAURIDSEN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 RILL DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7524
Mailing Address - Country:US
Mailing Address - Phone:407-435-5013
Mailing Address - Fax:
Practice Address - Street 1:661 SEMINOLA BLVD
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-3057
Practice Address - Country:US
Practice Address - Phone:407-678-6655
Practice Address - Fax:407-696-6999
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health