Provider Demographics
NPI:1912485616
Name:RUNGE, LORI JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:JEAN
Last Name:RUNGE
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 1:3933 WINDFORD DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-2069
Mailing Address - Country:US
Mailing Address - Phone:605-595-7375
Mailing Address - Fax:
Practice Address - Street 1:4315 WINDSOR CENTRE TRL STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1824
Practice Address - Country:US
Practice Address - Phone:972-268-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203236106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist