MEDICARE: DANIELLE LAWLESS

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1124593876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE LAWLESS

Provider Business Mailing Address
First Line	:	1400 E 12 MILE RD
Second Line	:
City	:	MADISON HTS
State	:	MI
Zip	:	48071-2651
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 E 12 MILE RD
Second Line	:
City	:	MADISON HTS
State	:	MI
Zip	:	48071-2651
Country	:	US
Telephone Number	:	248-658-1116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2018
Last Update Date	:	10/09/2018

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Directions to “ DANIELLE LAWLESS ” Practice Location

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