Healthcare Provider Details

I. General information

NPI: 1568886943
Provider Name (Legal Business Name): ROBERT CARR LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5031 PARK LAKE RD
EAST LANSING MI
48823-3835
US

IV. Provider business mailing address

5031 PARK LAKE RD
EAST LANSING MI
48823-3835
US

V. Phone/Fax

Practice location:
  • Phone: 517-332-0811
  • Fax:
Mailing address:
  • Phone: 517-332-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301010427
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: