Healthcare Provider Details

I. General information

NPI: 1497800163
Provider Name (Legal Business Name): JAMES ALFRED LEBLANC M.S. LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12072 W LAKESHORE DR
BRIMLEY MI
49715-9318
US

IV. Provider business mailing address

12072 W LAKESHORE DR
BRIMLEY MI
49715-9318
US

V. Phone/Fax

Practice location:
  • Phone: 906-248-3387
  • Fax:
Mailing address:
  • Phone: 906-248-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006074
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: