Provider Demographics
NPI:1356026462
Name:CRAVENS, LORI ELIZABETH
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ELIZABETH
Last Name:CRAVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ELIZABETH
Other - Last Name:ATWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 JEWELL LN SPC 32
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-4862
Mailing Address - Country:US
Mailing Address - Phone:406-830-8497
Mailing Address - Fax:
Practice Address - Street 1:3617 RICARDO AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2653
Practice Address - Country:US
Practice Address - Phone:307-221-1145
Practice Address - Fax:530-722-1115
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)