Provider Demographics
NPI:1467512392
Name:CRAIG, LORENA (LCPC, LAC)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E 7TH ST
Mailing Address - Street 2:2ND FLOOR SUITE I
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 E 7TH ST
Practice Address - Street 2:2ND FLOOR SUITE I
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2900
Practice Address - Country:US
Practice Address - Phone:406-563-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0256717Medicaid