Provider Demographics
NPI:1801424858
Name:LORI PAHL
Entity type:Organization
Organization Name:LORI PAHL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PAHL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-432-3779
Mailing Address - Street 1:1992 SUGARBUSH DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9489
Mailing Address - Country:US
Mailing Address - Phone:720-432-3779
Mailing Address - Fax:
Practice Address - Street 1:1992 SUGARBUSH DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9489
Practice Address - Country:US
Practice Address - Phone:720-432-3779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty