Provider Demographics
NPI:1831459106
Name:LORENZ, TARA MCRAE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:MCRAE
Last Name:LORENZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:C
Other - Last Name:MCRAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:307 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:NEW SALEM
Mailing Address - State:ND
Mailing Address - Zip Code:58563-4101
Mailing Address - Country:US
Mailing Address - Phone:707-530-5098
Mailing Address - Fax:
Practice Address - Street 1:1500 14TH ST W STE 290
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4078
Practice Address - Country:US
Practice Address - Phone:701-334-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW629001041C0700X
NDLICSW54761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical