Healthcare Provider Details

I. General information

NPI: 1174316632
Provider Name (Legal Business Name): MICHELLE LEE LOPEZ LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 W LAKE LANSING RD STE 300
EAST LANSING MI
48823-8452
US

IV. Provider business mailing address

4245 W JOLLY RD LOT 155
LANSING MI
48911-3061
US

V. Phone/Fax

Practice location:
  • Phone: 517-220-4710
  • Fax:
Mailing address:
  • Phone: 517-391-9496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851120243
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: