Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 6401010065 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301008586 | MI |
Y | 103G00000X | Clinical Psychologist | 6361001644 | MI |
Y | 103TC0700X | Clinical Psychologist | 6361001644 | MI |
NPI | 1043267040 |
---|---|
Provider Name | Mrs. Joan Frances Lazar |
First Address | West Bloomfield, MI 48322-4405 |
Second Address | West Bloomfield, MI 48322-4405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 10/03/2021 |