Individual
JACOB LORENZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA, MHP
Contact information
Practice address
101 OLIVER ST, VIENNA, IL 62995-1660
(618) 658-2611
(618) 658-2501
Mailing address
101 OLIVER ST, VIENNA, IL 62995-1660
(618) 658-2611
(618) 658-2501
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/03/2020
Last updated
06/03/2020
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