Healthcare Provider Details

I. General information

NPI: 1902192255
Provider Name (Legal Business Name): JOSEPH E LAIRD LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 JEWETT RD
MASON MI
48854-8729
US

IV. Provider business mailing address

585 JEWETT RD
MASON MI
48854-8729
US

V. Phone/Fax

Practice location:
  • Phone: 517-676-5405
  • Fax: 517-676-5460
Mailing address:
  • Phone: 517-676-5405
  • Fax: 517-676-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401014090
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: