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Provider Information for 1043789928


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LORA HALE STRYKER LCSW


Sex: Female

NPI: 1043789928
Last Updated: 2018-11-20
Certification Date:

Details

NameValue
NPI1043789928
Enumeration Date2018-11-20
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 325 N W C OWEN AVE
CLEWISTON, FL 33440-2811
United States

Phone: 954-242-1670 | Fax:
 
Primary Practice Address 1100 S OLYMPIA ST
CLEWISTON, FL 33440-4400
United States

Phone: 863-302-6022 | Fax:863-265-6018
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101YM0800X - Counselor - Mental HealthFL155531
Yes 1041C0700X - Social Worker - ClinicalFL155531