Healthcare Provider Details

I. General information

NPI: 1013920636
Provider Name (Legal Business Name): LORI A HEALY MA, LLP, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14223 S FRANCISCO RD
GRASS LAKE MI
49240-9815
US

IV. Provider business mailing address

14223 S FRANCISCO RD
GRASS LAKE MI
49240-9815
US

V. Phone/Fax

Practice location:
  • Phone: 810-204-5731
  • Fax:
Mailing address:
  • Phone: 810-204-5731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6301010410
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301010410
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361004537
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: