Provider Demographics
NPI:1689171654
Name:DAVENPORT, LORI LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E PARK DR
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4442
Mailing Address - Country:US
Mailing Address - Phone:928-970-1027
Mailing Address - Fax:
Practice Address - Street 1:901 E PARK DR
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4442
Practice Address - Country:US
Practice Address - Phone:928-970-1027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17175101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional