Provider Demographics
NPI:1740481985
Name:NEWSOME, LORIEN JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:LORIEN
Middle Name:JEAN
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 N MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-8636
Mailing Address - Country:US
Mailing Address - Phone:734-788-8364
Mailing Address - Fax:253-341-4944
Practice Address - Street 1:426 N MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8636
Practice Address - Country:US
Practice Address - Phone:734-788-8364
Practice Address - Fax:253-341-4944
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAPY60249985103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program