Healthcare Provider Details

I. General information

NPI: 1831627819
Provider Name (Legal Business Name): LA TOSHA LYMON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30150 TELEGRAPH RD STE 245
BINGHAM FARMS MI
48025-4521
US

IV. Provider business mailing address

31268 SHORECREST DR APT 24302
NOVI MI
48377-1182
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax: 248-605-3525
Mailing address:
  • Phone: 248-763-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401018942
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: