Provider Demographics
NPI:1972638427
Name:THULI, LORI MARIE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:MARIE
Last Name:THULI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6016 COUNTY ROAD A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:WI
Mailing Address - Zip Code:53521-9455
Mailing Address - Country:US
Mailing Address - Phone:608-843-2803
Mailing Address - Fax:
Practice Address - Street 1:1200 N CENTER ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-1166
Practice Address - Country:US
Practice Address - Phone:920-887-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI731-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist