Provider Demographics
NPI:1518017029
Name:LONSBERRY, LORA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:
Last Name:LONSBERRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 N FOYS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7460
Mailing Address - Country:US
Mailing Address - Phone:406-752-6634
Mailing Address - Fax:406-752-0572
Practice Address - Street 1:455 N FOYS LAKE DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-7460
Practice Address - Country:US
Practice Address - Phone:406-752-6634
Practice Address - Fax:406-752-0572
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional