Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 6301010410 | MI |
Y | 102L00000X | Psychologist | 6301010410 | MI |
Y | 103T00000X | Psychologist | 6301010410 | MI |
NPI | 1013920636 |
---|---|
Provider Name | Lori A Healy |
First Address | Kalamazoo, MI 49007 |
Second Address | Kalamazoo, MI 49007-9520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 14/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
750910475 | BCBS PIN (01) | MI |