MEDICARE: LAZARUSMAN CONSULTING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist
2	103TC2200X	Clinical Child & Adolescent Psychologist
3	103T00000X	Psychologist

General Provider Information

NPI Number	:	1972137883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAZARUSMAN CONSULTING, PLLC

Provider Business Mailing Address
First Line	:	2416 PECK ST
Second Line	:
City	:	MUSKEGON HTS
State	:	MI
Zip	:	49444-1431
Country	:	US
Telephone Number	:	231-747-6197
Fax Number	:

Provider Business Practice Location Address
First Line	:	2416 PECK ST
Second Line	:
City	:	MUSKEGON HTS
State	:	MI
Zip	:	49444-1431
Country	:	US
Telephone Number	:	231-747-6197
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CEDRIC H SCOTT
Credential	:	LLP
Telephone Number	:	231-747-6197

Provider Enumeration Date	:	02/29/2020
Last Update Date	:	02/29/2020

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