Provider Demographics
NPI:1609297258
Name:MARTIN, LORI ANN (MA, LPCC)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:280 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2424
Practice Address - Country:US
Practice Address - Phone:651-241-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-29
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional