Provider Demographics
NPI:1174926489
Name:VAN MATRE, LORA CHARLENE
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:CHARLENE
Last Name:VAN MATRE
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 1:1092 ASPEN CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-2523
Mailing Address - Country:US
Mailing Address - Phone:740-777-2498
Mailing Address - Fax:
Practice Address - Street 1:3430 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5003
Practice Address - Country:US
Practice Address - Phone:702-749-3200
Practice Address - Fax:702-749-3202
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor