Provider Demographics
NPI:1689679177
Name:HORSTMEYER-GRUBB, LORI LEE (LMHC, BCPC)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LEE
Last Name:HORSTMEYER-GRUBB
Suffix:
Gender:F
Credentials:LMHC, BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5024
Mailing Address - Country:US
Mailing Address - Phone:260-750-9678
Mailing Address - Fax:260-387-7413
Practice Address - Street 1:1816 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5024
Practice Address - Country:US
Practice Address - Phone:260-750-9678
Practice Address - Fax:260-387-7413
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001483A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200912670AMedicaid