Provider Demographics
NPI:1932212685
Name:GERLACH, LORRAINE (EDD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:GERLACH
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E. CENTER
Mailing Address - Street 2:SUITE A
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-233-1675
Mailing Address - Fax:208-234-3660
Practice Address - Street 1:850 E CENTER ST
Practice Address - Street 2:SUITE A
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5737
Practice Address - Country:US
Practice Address - Phone:208-233-1675
Practice Address - Fax:208-234-3660
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID37101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health