Provider Demographics
NPI:1205424777
Name:LORENTZEN, EMILY REBECCA
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:REBECCA
Last Name:LORENTZEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 2ND ST W UNIT A
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-3075
Mailing Address - Country:US
Mailing Address - Phone:406-298-5728
Mailing Address - Fax:406-730-2488
Practice Address - Street 1:144 2ND ST W UNIT A
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-3075
Practice Address - Country:US
Practice Address - Phone:406-298-5728
Practice Address - Fax:406-730-2488
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT326561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical