Provider Demographics
NPI:1235358359
Name:BOHR, LORI JORDAN (LCSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JORDAN
Last Name:BOHR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4542 N 18TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3841
Mailing Address - Country:US
Mailing Address - Phone:602-277-7534
Mailing Address - Fax:602-271-2963
Practice Address - Street 1:2920 N 34TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-5250
Practice Address - Country:US
Practice Address - Phone:602-764-0802
Practice Address - Fax:602-271-2963
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-34871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical