Healthcare Provider Details

I. General information

NPI: 1710172341
Provider Name (Legal Business Name): BARBARA JEAN LAUGHBAUM L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PLEASANTVIEW RD
PELLSTON MI
49769-9047
US

IV. Provider business mailing address

1800 PLEASANTVIEW RD
PELLSTON MI
49769-9047
US

V. Phone/Fax

Practice location:
  • Phone: 231-539-8631
  • Fax:
Mailing address:
  • Phone: 231-539-8631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberL1056148
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: