Provider Demographics
NPI:1053067629
Name:LITTLE LAKE PSYCHIATRY AND THERAPY SERVICES PLLC
Entity Type:Organization
Organization Name:LITTLE LAKE PSYCHIATRY AND THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLACHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-304-7056
Mailing Address - Street 1:405 LITTLE LAKE DR STE A9
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 LITTLE LAKE DR STE A9
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6220
Practice Address - Country:US
Practice Address - Phone:734-404-8188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health