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General NPI Number Information
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NPI Number | 1386784874
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Entity Type | Organization
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Legal Business Name | FAMILY THERAPY CONNECTIONS
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2815 S PENNSYLVANIA AVE SUITE #2
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City | LANSING
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State | MI
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Zip | 48910-3496
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Country | US
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Telephone | 517-377-8648
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Fax | 517-377-8595
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Provider Business Mailing Address
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Address Line | 2815 S PENNSYLVANIA AVE SUITE #2
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City | LANSING
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State | MI
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Zip | 48910-3496
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Country | US
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Telephone | 517-377-8648
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Fax | 517-377-8595
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | DR. LAURA ANN MOHR
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Credential | PH.D
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Telephone | 517-377-8648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 4101006215
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License Number State | MI
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