Provider Demographics
NPI:1518187541
Name:LAUREL PK REHAB AND COUN INC
Entity Type:Organization
Organization Name:LAUREL PK REHAB AND COUN INC
Other - Org Name:LAUREL PARK REHABILITATION AND COUNSELING INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:WALSH
Authorized Official - Last Name:TRAPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-432-1950
Mailing Address - Street 1:PO BOX 530733
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48153
Mailing Address - Country:US
Mailing Address - Phone:734-432-1950
Mailing Address - Fax:734-432-0325
Practice Address - Street 1:15821 MARSHA ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-432-1950
Practice Address - Fax:734-432-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1558106101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty