Healthcare Provider Details

I. General information

NPI: 1649661406
Provider Name (Legal Business Name): SHARON RAE LENON LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 TURNER ST SUITE 1
LANSING MI
48906-4373
US

IV. Provider business mailing address

1714 MAPLEWOOD AVE
LANSING MI
48910-1523
US

V. Phone/Fax

Practice location:
  • Phone: 517-574-4197
  • Fax:
Mailing address:
  • Phone: 517-487-9959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012691
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: