Healthcare Provider Details

I. General information

NPI: 1972137883
Provider Name (Legal Business Name): LAZARUSMAN CONSULTING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2020
Last Update Date: 02/29/2020
Certification Date: 02/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 PECK ST
MUSKEGON HTS MI
49444-1431
US

IV. Provider business mailing address

2416 PECK ST
MUSKEGON HTS MI
49444-1431
US

V. Phone/Fax

Practice location:
  • Phone: 231-747-6197
  • Fax:
Mailing address:
  • Phone: 231-747-6197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. CEDRIC H SCOTT
Title or Position: OWNER
Credential: LLP
Phone: 231-747-6197