Provider Demographics
NPI:1366675977
Name:COSTELLO, LORI LYNN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LYNN
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W RANDOL MILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3159
Mailing Address - Country:US
Mailing Address - Phone:214-629-3743
Mailing Address - Fax:
Practice Address - Street 1:1414 W RANDOL MILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3159
Practice Address - Country:US
Practice Address - Phone:214-629-3743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-30
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62819101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor