Provider Demographics
NPI:1235331505
Name:LORENZ, MARJORIE ELAINE (MA LMHC)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ELAINE
Last Name:LORENZ
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:MS
Other - First Name:MARGIE
Other - Middle Name:ELAINE
Other - Last Name:MIDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LMHC
Mailing Address - Street 1:11636 SE 5TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3527
Mailing Address - Country:US
Mailing Address - Phone:206-799-2454
Mailing Address - Fax:425-590-9405
Practice Address - Street 1:11636 SE 5TH ST
Practice Address - Street 2:STE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3527
Practice Address - Country:US
Practice Address - Phone:206-799-2454
Practice Address - Fax:425-590-9405
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007527101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor