Provider Demographics
NPI:1396024543
Name:LORENZ, DAMON
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:LORENZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21180 N 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-6497
Mailing Address - Country:US
Mailing Address - Phone:623-412-5225
Mailing Address - Fax:623-412-5232
Practice Address - Street 1:21180 N 87TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-6497
Practice Address - Country:US
Practice Address - Phone:623-412-5225
Practice Address - Fax:623-412-5232
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4399230103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool