Provider Demographics
NPI:1700227584
Name:STAFF, LORI DAWN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:DAWN
Last Name:STAFF
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 1:550 ORANGE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3242
Mailing Address - Country:US
Mailing Address - Phone:951-662-2820
Mailing Address - Fax:
Practice Address - Street 1:550 ORANGE ST
Practice Address - Street 2:SUITE E
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-3242
Practice Address - Country:US
Practice Address - Phone:951-662-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist