Provider Demographics
NPI:1396882262
Name:MINER, LORA MICHELLE (LCPC)
Entity type:Individual
Prefix:MS
First Name:LORA
Middle Name:MICHELLE
Last Name:MINER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:L.
Other - Middle Name:MICHELLE
Other - Last Name:MINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:53 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-9111
Mailing Address - Country:US
Mailing Address - Phone:309-363-2060
Mailing Address - Fax:
Practice Address - Street 1:53 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-9111
Practice Address - Country:US
Practice Address - Phone:309-363-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003093101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)