Provider Demographics
NPI:1609188382
Name:ANAFARTA, LORI J (LMFT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:ANAFARTA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-1508
Mailing Address - Country:US
Mailing Address - Phone:651-775-2084
Mailing Address - Fax:
Practice Address - Street 1:344 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-1508
Practice Address - Country:US
Practice Address - Phone:651-775-2084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2028106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist