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General NPI Number Information
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NPI Number | 1770205585
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Entity Type | Individual
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Provider Name | MISTY LYNN LAFREE LLPC
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Gender | Female
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 217 E 24TH ST STE 201
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City | HOLLAND
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State | MI
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Zip | 49423-4973
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Country | US
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Telephone | 616-209-8249
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 DORROLL ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-4320
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Country | US
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Telephone | 616-581-8489
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451019711
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License Number State | MI
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