Provider Demographics
NPI:1376008920
Name:LORSON, LINDSAY MARIE
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MARIE
Last Name:LORSON
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 1:5288 TAZ CIRCLE DR NW
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49676-8706
Mailing Address - Country:US
Mailing Address - Phone:915-539-7384
Mailing Address - Fax:
Practice Address - Street 1:5288 TAZ CIRCLE DR NW
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:MI
Practice Address - Zip Code:49676-8706
Practice Address - Country:US
Practice Address - Phone:915-539-7384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3848103K00000X
TX1049851041C0700X
MI68011155921041C0700X, 104100000X
TNRBT-18-57639106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician