Provider Demographics
NPI:1760966030
Name:LORENTZEN, LEAH JO (LPCC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:JO
Last Name:LORENTZEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:JO
Other - Last Name:ROYSETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2637 27TH AVE S # 248
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1565
Mailing Address - Country:US
Mailing Address - Phone:612-548-4459
Mailing Address - Fax:612-465-1157
Practice Address - Street 1:2637 27TH AVE S # 248
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1565
Practice Address - Country:US
Practice Address - Phone:612-548-4459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC04656101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health