Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401011751 | MI |
NPI | 1003113713 |
---|---|
Provider Name | Ms. Lynette Lange |
First Address | Monroe, MI 48161-3880 |
Second Address | Monroe, MI 48161-3880 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2011 |
Last Update Date | 15/02/2011 |