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General NPI Number Information
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NPI Number | 1912523218
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Entity Type | Individual
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Provider Name | JONATHAN WESLEY LAWRENCE LLMSW
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Gender | Male
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 2111 UNIVERSITY PARK DR STE 400
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City | OKEMOS
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State | MI
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Zip | 48864-6907
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Country | US
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Telephone | 517-881-8082
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 BERWICK DR
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City | LANSING
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State | MI
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Zip | 48911-2173
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Country | US
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Telephone | 517-881-8082
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801107365
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License Number State | MI
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