Provider Demographics
NPI:1518241785
Name:LORENSON, TARA MARY (LIMHP, MSW)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:MARY
Last Name:LORENSON
Suffix:
Gender:F
Credentials:LIMHP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20066 S 190TH ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:NE
Mailing Address - Zip Code:68301-3023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20066 S 190TH ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:NE
Practice Address - Zip Code:68301-3023
Practice Address - Country:US
Practice Address - Phone:402-440-2283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health