Provider Demographics
NPI:1568867463
Name:LAWRENCE, DENNIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 HIDEAWAY VALLEY DR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-8400
Mailing Address - Country:US
Mailing Address - Phone:231-881-7311
Mailing Address - Fax:
Practice Address - Street 1:1185 HIDEAWAY VALLEY DR
Practice Address - Street 2:SUITE #4
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-8400
Practice Address - Country:US
Practice Address - Phone:231-881-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011827103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist