Healthcare Provider Details

I. General information

NPI: 1902899974
Provider Name (Legal Business Name): PATRICIA J LAFAVE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SPRING ARBOR RD SUITE 800
JACKSON MI
49203-8605
US

IV. Provider business mailing address

6602 LAKESHORE RD
BURTCHVILLE MI
48059-2213
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-2442
  • Fax: 517-782-0310
Mailing address:
  • Phone: 810-385-4953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301002176
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: