Provider Demographics
NPI:1154714244
Name:LINDENAUX-BALAZS, LORELEI
Entity type:Individual
Prefix:
First Name:LORELEI
Middle Name:
Last Name:LINDENAUX-BALAZS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 GOLDRUSH LN
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2120
Mailing Address - Country:US
Mailing Address - Phone:941-224-5681
Mailing Address - Fax:
Practice Address - Street 1:1500 INDEPENDENCE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2170
Practice Address - Country:US
Practice Address - Phone:941-359-1927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health