Healthcare Provider Details

I. General information

NPI: 1700104460
Provider Name (Legal Business Name): MR. MICHAEL FRANCIS LAGROU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 08/03/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 S CEDAR ST
LANSING MI
48910-5474
US

IV. Provider business mailing address

4902 S CEDAR ST
LANSING MI
48910-5474
US

V. Phone/Fax

Practice location:
  • Phone: 517-394-7867
  • Fax:
Mailing address:
  • Phone: 517-394-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801092216
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: