MEDICARE: MRS. LARA SCHAIBLE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	101Y00000X	Counselor

General Provider Information

NPI Number	:	1699081000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LARA SCHAIBLE LPC

Provider Business Mailing Address
First Line	:	826 PARCHMENT DR SE STE 100
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2307
Country	:	US
Telephone Number	:	616-362-1645
Fax Number	:

Provider Business Practice Location Address
First Line	:	826 PARCHMENT DR SE STE 100
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2307
Country	:	US
Telephone Number	:	616-326-1645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	09/26/2018

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