Provider Demographics
NPI:1851575807
Name:VINSON, LORI JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:VINSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:JEAN
Other - Last Name:VINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:321 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-3201
Mailing Address - Country:US
Mailing Address - Phone:903-657-9717
Mailing Address - Fax:
Practice Address - Street 1:1814 US HIGHWAY 79 S
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654-4502
Practice Address - Country:US
Practice Address - Phone:903-657-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191686803Medicaid