Provider Demographics
NPI:1689212821
Name:KIDD, LORI ANN (LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:KIDD
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 1:1584 W CLIFF ROSE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7434
Mailing Address - Country:US
Mailing Address - Phone:928-910-3176
Mailing Address - Fax:
Practice Address - Street 1:246 S CORTEZ ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-3939
Practice Address - Country:US
Practice Address - Phone:928-910-3176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15985101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional