MEDICARE: LITTLE LAKE PSYCHIATRY AND THERAPY SERVICES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1053067629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE LAKE PSYCHIATRY AND THERAPY SERVICES PLLC

Provider Business Mailing Address
First Line	:	405 LITTLE LAKE DR STE A9
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-6220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 LITTLE LAKE DR STE A9
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-6220
Country	:	US
Telephone Number	:	734-404-8188
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALISA SCHLACHT
Credential	:	DO
Telephone Number	:	517-304-7056

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	03/27/2022

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