Provider Demographics
NPI:1063209849
Name:LORBACK, LOIS (CCHT)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:LORBACK
Suffix:
Gender:
Credentials:CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28632 ROADSIDE DR STE 170
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-6083
Mailing Address - Country:US
Mailing Address - Phone:818-309-9927
Mailing Address - Fax:
Practice Address - Street 1:28632 ROADSIDE DR STE 170
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-6083
Practice Address - Country:US
Practice Address - Phone:818-309-9927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health