Provider Demographics
NPI:1407551195
Name:LAWTON, WESLEY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:LAWTON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51382 GRATIOT AVE # 1074
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2035
Mailing Address - Country:US
Mailing Address - Phone:586-576-6523
Mailing Address - Fax:
Practice Address - Street 1:191 NORTH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-9703
Practice Address - Country:US
Practice Address - Phone:586-576-6523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019199101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health