Provider Demographics
NPI:1376711689
Name:BERRY, LORI TIMMONS (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:TIMMONS
Last Name:BERRY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:TIMMONS
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:9838 HIDDEN BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-5022
Mailing Address - Country:US
Mailing Address - Phone:318-688-2525
Mailing Address - Fax:
Practice Address - Street 1:9838 HIDDEN BRANCH LANE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118
Practice Address - Country:US
Practice Address - Phone:318-603-1892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMFT881106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist