Provider Demographics
NPI:1972638351
Name:EBRIGHT, LORRAINE EDYTHE (MC MASTERS IN COUNSE)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:EDYTHE
Last Name:EBRIGHT
Suffix:
Gender:F
Credentials:MC MASTERS IN COUNSE
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:EDYTHE
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21114 EAST STIRRUP STREET
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242
Mailing Address - Country:US
Mailing Address - Phone:480-882-2624
Mailing Address - Fax:
Practice Address - Street 1:1830 S ALMA SCHOOL
Practice Address - Street 2:SUITE 112
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201
Practice Address - Country:US
Practice Address - Phone:480-730-6222
Practice Address - Fax:480-730-3513
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC0293101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor