Provider Demographics
NPI:1467636720
Name:IVANETS, LOREE M (LAC, NCAC II)
Entity Type:Individual
Prefix:MS
First Name:LOREE
Middle Name:M
Last Name:IVANETS
Suffix:
Gender:F
Credentials:LAC, NCAC II
Other - Prefix:MS
Other - First Name:LOREE
Other - Middle Name:M
Other - Last Name:BASARABA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAC
Mailing Address - Street 1:1463 I94 BUSINESS LOOP E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-6434
Mailing Address - Country:US
Mailing Address - Phone:701-227-7500
Mailing Address - Fax:701-227-7575
Practice Address - Street 1:1463 I94 BUSINESS LOOP E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-6434
Practice Address - Country:US
Practice Address - Phone:701-227-7500
Practice Address - Fax:701-227-7575
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 174400000X
ND1340101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist