Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 6301018188 | MI |
N | 103T00000X | Psychologist | 6301018188 | MI |
Y | 103G00000X | Clinical Psychologist | 6301018188 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301018188 | MI |
NPI | 1003443177 |
---|---|
Provider Name | Dr. Lara N Coughlin |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2020 |
Last Update Date | 15/06/2020 |