Healthcare Provider Details

I. General information

NPI: 1013339043
Provider Name (Legal Business Name): PAWEL LAZARCZYK M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 SW BAYA DR
LAKE CITY FL
32025-4209
US

IV. Provider business mailing address

320 SW RED MAPLE WAY
LAKE CITY FL
32024-3706
US

V. Phone/Fax

Practice location:
  • Phone: 386-754-9005
  • Fax:
Mailing address:
  • Phone: 843-290-2435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: