Healthcare Provider Details

I. General information

NPI: 1487120804
Provider Name (Legal Business Name): COLBY LAWRENCE LAPERRIERE LLPC, NCC, ACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S WESTNEDGE AVE
KALAMAZOO MI
49008-1166
US

IV. Provider business mailing address

401 HOWARD ST
BATTLE CREEK MI
49037
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-4458
  • Fax:
Mailing address:
  • Phone: 269-344-4458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016865
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: