Provider Demographics
NPI:1972204741
Name:NEWSOM, LORI ANNE (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANNE
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S AUBURNDALE ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3916
Mailing Address - Country:US
Mailing Address - Phone:901-729-3900
Mailing Address - Fax:
Practice Address - Street 1:35 S AUBURNDALE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3916
Practice Address - Country:US
Practice Address - Phone:901-729-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4850101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor