Healthcare Provider Details

I. General information

NPI: 1083073753
Provider Name (Legal Business Name): INDIRA VAZGEC LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W WILLOW ST
LANSING MI
48917-1833
US

IV. Provider business mailing address

2800 W WILLOW ST
LANSING MI
48917-1833
US

V. Phone/Fax

Practice location:
  • Phone: 517-323-4734
  • Fax: 517-886-1158
Mailing address:
  • Phone: 517-323-4734
  • Fax: 517-886-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801098112
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: