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General NPI Number Information
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NPI Number | 1518187541
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Entity Type | Organization
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Legal Business Name | LAUREL PK REHAB AND COUN INC
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15821 MARSHA ST
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City | LIVONIA
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State | MI
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Zip | 48154
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Country | US
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Telephone | 734-432-1950
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Fax | 734-432-0325
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Provider Business Mailing Address
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Address Line | PO BOX 530733
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City | LIVONIA
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State | MI
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Zip | 48153
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Country | US
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Telephone | 734-432-1950
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Fax | 734-432-0325
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | DR. BARBARA WALSH TRAPP
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Credential | PHD
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Telephone | 734-432-1950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1558106
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License Number State | MI
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