MEDICARE: LAURA CONSTABLE LLC

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	6451023332	MI

General Provider Information

NPI Number	:	1982478749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA CONSTABLE LLC

Provider Business Mailing Address
First Line	:	12402 WOODHULL LNDG
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-9763
Country	:	US
Telephone Number	:	810-444-9801
Fax Number	:

Provider Business Practice Location Address
First Line	:	3075 E GRAND RIVER AVE STE 100
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48843-6585
Country	:	US
Telephone Number	:	517-741-0470
Fax Number	:

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

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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Directions to “ LAURA CONSTABLE LLC” Practice Location

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