Provider Demographics
NPI:1144800681
Name:CRAVEN, LORI (LCDC INTERN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:LCDC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 MCCART AVE
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-3711
Mailing Address - Country:US
Mailing Address - Phone:817-207-8700
Mailing Address - Fax:
Practice Address - Street 1:5201 MCCART AVE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-3711
Practice Address - Country:US
Practice Address - Phone:817-207-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48721101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)