Provider Demographics
NPI:1417418351
Name:LOREN, NANCI
Entity Type:Individual
Prefix:
First Name:NANCI
Middle Name:
Last Name:LOREN
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 1:21 PRATER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:TX
Mailing Address - Zip Code:77371-3249
Mailing Address - Country:US
Mailing Address - Phone:832-264-4138
Mailing Address - Fax:
Practice Address - Street 1:21 PRATER DRIVE
Practice Address - Street 2:
Practice Address - City:SHEPHERD
Practice Address - State:TX
Practice Address - Zip Code:77371-3249
Practice Address - Country:US
Practice Address - Phone:832-264-4138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX35177OtherOTHER