Provider Demographics
NPI:1912673260
Name:MAZE, LORI ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:MAZE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LUKE LN
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3063
Mailing Address - Country:US
Mailing Address - Phone:309-831-6007
Mailing Address - Fax:
Practice Address - Street 1:1821 WESTINGHOUSE RD STE 1150
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7645
Practice Address - Country:US
Practice Address - Phone:512-763-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1054311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical