Provider Demographics
NPI:1861645020
Name:KURTZ, LORI ANN (LPC, LPB, LADC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:KURTZ
Suffix:
Gender:F
Credentials:LPC, LPB, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 SKY LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-3841
Mailing Address - Country:US
Mailing Address - Phone:918-533-0308
Mailing Address - Fax:918-542-8815
Practice Address - Street 1:130 A ST NE
Practice Address - Street 2:SUITE 110
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6332
Practice Address - Country:US
Practice Address - Phone:918-533-0308
Practice Address - Fax:918-542-8815
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0141101Y00000X
OK333101YA0400X
OK2718101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)