Provider Demographics
NPI:1114314473
Name:JABOLA, LORENE (PHD, LMFT)
Entity Type:Individual
Prefix:
First Name:LORENE
Middle Name:
Last Name:JABOLA
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 E 78TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-4638
Mailing Address - Country:US
Mailing Address - Phone:612-767-1683
Mailing Address - Fax:
Practice Address - Street 1:1550 E 78TH ST FL 1
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-4638
Practice Address - Country:US
Practice Address - Phone:612-767-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2366106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist