Provider Demographics
NPI:1275751406
Name:LAHAIE, BAMBI A (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:BAMBI
Middle Name:A
Last Name:LAHAIE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:BAMBI
Other - Middle Name:A
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:125 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442
Mailing Address - Country:US
Mailing Address - Phone:231-726-3582
Mailing Address - Fax:231-722-6933
Practice Address - Street 1:125 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442
Practice Address - Country:US
Practice Address - Phone:231-726-3582
Practice Address - Fax:231-722-6933
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010839931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBL083993OtherBCBS
MIBL083993OtherBCBS