Provider Demographics
NPI:1235357732
Name:LAHAIE, ANDREW HENRY (LLP)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:HENRY
Last Name:LAHAIE
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18546 SHAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-9417
Mailing Address - Country:US
Mailing Address - Phone:616-847-0920
Mailing Address - Fax:
Practice Address - Street 1:173 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3463
Practice Address - Country:US
Practice Address - Phone:231-724-6050
Practice Address - Fax:231-724-6066
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007234103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAL007234OtherBCBS PIN