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NPI Code Detail

MEDICARE: LAURA ALTON MS, LLP

MEDICARE: LAURA ALTON MS, LLP
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
1103T00000XPsychologist6301009609MI

General Provider Information

NPI Number : 1114160306
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA ALTON MS, LLP
Provider Business Mailing Address
First Line : 2715 S TOWNLINE RD
Second Line :
City : HOUGHTON LAKE
State : MI
Zip : 48629-9294
Country : US
Telephone Number : 989-366-8550
Fax Number :
Provider Business Practice Location Address
First Line : 2715 S TOWNLINE RD
Second Line :
City : HOUGHTON LAKE
State : MI
Zip : 48629-9294
Country : US
Telephone Number : 989-366-8550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2009
Last Update Date : 04/17/2009

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