Provider Demographics
NPI:1497932081
Name:PATRICIA J LAFAVE P H D & ASSOCIATES P C
Entity Type:Organization
Organization Name:PATRICIA J LAFAVE P H D & ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHD
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAFAVE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:517-782-2442
Mailing Address - Street 1:3333 SPRING ARBOR RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-8605
Mailing Address - Country:US
Mailing Address - Phone:517-782-2442
Mailing Address - Fax:517-782-0310
Practice Address - Street 1:3333 SPRING ARBOR RD
Practice Address - Street 2:SUITE 800
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-8605
Practice Address - Country:US
Practice Address - Phone:517-782-2442
Practice Address - Fax:517-782-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103T00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1902899974Medicare NSC
MI1245362664Medicare NSC
MI1437161536Medicare NSC
MI1013900901Medicare NSC
MI1124011192Medicare NSC
MI1265424535Medicare NSC
MI1366482861Medicare NSC
MIOM38330Medicare PIN