Healthcare Provider Details

I. General information

NPI: 1760928493
Provider Name (Legal Business Name): EMMETT LINCOLN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 PARKVIEW AVE STE 1
KALAMAZOO MI
49008-4806
US

IV. Provider business mailing address

1901 PARKVIEW AVE STE 1
KALAMAZOO MI
49008-4806
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 269-207-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number41510011236
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: