Provider Demographics
NPI:1386301968
Name:LORENTY, MARLIZ IVETTE (LMFT-A)
Entity type:Individual
Prefix:MRS
First Name:MARLIZ
Middle Name:IVETTE
Last Name:LORENTY
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9717 SYDNEY MARILYN LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3086
Mailing Address - Country:US
Mailing Address - Phone:512-825-4618
Mailing Address - Fax:
Practice Address - Street 1:9430 RESEARCH BLVD.
Practice Address - Street 2:ECHELON 2, SUITE 140
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-919-4135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health