Provider Demographics
NPI:1417037060
Name:LOREN E. NOVAK & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:LOREN E. NOVAK & ASSOCIATES, INC.
Other - Org Name:LIFESTYLE COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:952-447-1117
Mailing Address - Street 1:14162 COMMERCE AVE NE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1480
Mailing Address - Country:US
Mailing Address - Phone:952-447-1117
Mailing Address - Fax:952-447-1116
Practice Address - Street 1:14162 COMMERCE AVE NE
Practice Address - Street 2:SUITE 400
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1480
Practice Address - Country:US
Practice Address - Phone:952-447-1117
Practice Address - Fax:952-447-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN810953-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8451554OtherUNITED BEHAVIOR HEALTH
MNNAOtherCIGNA
MN103171OtherU-CARE
MN1601OtherHEALTH PARTNERS
MN9105LIOtherBC/BS