MEDICARE: DR. DENNIS LAWRENCE PSY.D.

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	103T00000X	Psychologist	6301011827	MI

General Provider Information

NPI Number	:	1568867463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS LAWRENCE PSY.D.

Provider Business Mailing Address
First Line	:	1185 HIDEAWAY VALLEY DR
Second Line	:	SUITE #4
City	:	HARBOR SPRINGS
State	:	MI
Zip	:	49740-8400
Country	:	US
Telephone Number	:	231-881-7311
Fax Number	:

Provider Business Practice Location Address
First Line	:	1185 HIDEAWAY VALLEY DR
Second Line	:	SUITE #4
City	:	HARBOR SPRINGS
State	:	MI
Zip	:	49740-8400
Country	:	US
Telephone Number	:	231-881-7311
Fax Number	:

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

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	03/17/2018

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