Provider Demographics
NPI:1326510173
Name:LOREI, HENRIETTA
Entity Type:Individual
Prefix:
First Name:HENRIETTA
Middle Name:
Last Name:LOREI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3288 NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-3505
Mailing Address - Country:US
Mailing Address - Phone:614-246-1875
Mailing Address - Fax:
Practice Address - Street 1:27801 EUCLID AVE STE 520
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3500
Practice Address - Country:US
Practice Address - Phone:216-350-6836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional