MEDICARE: LEA EARLEY LPC

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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1396415550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEA EARLEY LPC

Provider Business Mailing Address
First Line	:	1830 N CENTER ST
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-4157
Country	:	US
Telephone Number	:	814-331-9295
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 N CENTER ST
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-4157
Country	:	US
Telephone Number	:	814-331-9295
Fax Number	:

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

Provider Enumeration Date	:	09/17/2021
Last Update Date	:	09/17/2021

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Directions to “ LEA EARLEY LPC” Practice Location

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