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NPI Code Detail

MEDICARE: DR. BRENDA KAREN LACOURSE PHD

MEDICARE: DR. BRENDA KAREN LACOURSE PHD
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
1103TC0700XClinical Psychologist6301011607MI

General Provider Information

NPI Number : 1063600278
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRENDA KAREN LACOURSE PHD
Provider Business Mailing Address
First Line : 801 MAXWELL AVE
Second Line :
City : ROYAL OAK
State : MI
Zip : 48067-1653
Country : US
Telephone Number : 248-547-5280
Fax Number :
Provider Business Practice Location Address
First Line : 1112 CATALPA DR
Second Line :
City : ROYAL OAK
State : MI
Zip : 48067-1125
Country : US
Telephone Number : 248-414-7275
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2007
Last Update Date : 07/26/2021

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