Healthcare Provider Details

I. General information

NPI: 1326811274
Provider Name (Legal Business Name): LHA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3772 SENEY DR
LAKE ORION MI
48360-2709
US

IV. Provider business mailing address

3772 SENEY DR
LAKE ORION MI
48360-2709
US

V. Phone/Fax

Practice location:
  • Phone: 248-592-7798
  • Fax:
Mailing address:
  • Phone: 248-592-7798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MENDOZA
Title or Position: ADMINISTRATOR
Credential:
Phone: 630-632-5822