Provider Demographics
NPI:1720540065
Name:TORGERSEN, LAWRENCE ROBERT (CO60862173)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ROBERT
Last Name:TORGERSEN
Suffix:
Gender:M
Credentials:CO60862173
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10912 W OLSON RD
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-9628
Mailing Address - Country:US
Mailing Address - Phone:509-270-3250
Mailing Address - Fax:
Practice Address - Street 1:10912 W OLSON RD
Practice Address - Street 2:
Practice Address - City:NINE MILE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99026-9628
Practice Address - Country:US
Practice Address - Phone:509-270-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1720540065OtherSELF