Provider Demographics
NPI:1396022851
Name:ENGBLOM, LORI JOANNE (MA, LPCC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:JOANNE
Last Name:ENGBLOM
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 FISH LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-7312
Mailing Address - Country:US
Mailing Address - Phone:320-980-4489
Mailing Address - Fax:
Practice Address - Street 1:1506 1ST ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1462
Practice Address - Country:US
Practice Address - Phone:763-389-5080
Practice Address - Fax:763-389-5453
Is Sole Proprietor?:No
Enumeration Date:2011-11-12
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional