Provider Demographics
NPI:1568432904
Name:LORING FAMILY THERAPY SERICES INC
Entity Type:Organization
Organization Name:LORING FAMILY THERAPY SERICES INC
Other - Org Name:LORING FAMILY CLINIC CLINIC FOR ATTENTION LEARNING AND MEMORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LP LMFT
Authorized Official - Phone:612-872-9072
Mailing Address - Street 1:430 OAK GROVE ST
Mailing Address - Street 2:STE 414
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3242
Mailing Address - Country:US
Mailing Address - Phone:612-872-9072
Mailing Address - Fax:612-872-5605
Practice Address - Street 1:430 OAK GROVE ST
Practice Address - Street 2:STE 414
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3242
Practice Address - Country:US
Practice Address - Phone:612-872-9072
Practice Address - Fax:612-872-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1794103T00000X
MNLP1733103T00000X
MNLMFT1146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty