Provider Demographics
NPI:1558656777
Name:GROVES, LORI EILEEN (MMFT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:EILEEN
Last Name:GROVES
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W HARRISON ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-2839
Mailing Address - Country:US
Mailing Address - Phone:219-866-7869
Mailing Address - Fax:219-866-0688
Practice Address - Street 1:219 W HARRISON ST
Practice Address - Street 2:SUITE 5
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-2839
Practice Address - Country:US
Practice Address - Phone:219-866-7869
Practice Address - Fax:219-866-0688
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist