Provider Demographics
NPI:1821269721
Name:LABRECQUE, LYNNETTE SUSANNE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LYNNETTE
Middle Name:SUSANNE
Last Name:LABRECQUE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LYNNETTE
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:6195 MILLER RD STE A
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1599
Mailing Address - Country:US
Mailing Address - Phone:810-630-1152
Mailing Address - Fax:
Practice Address - Street 1:6195 MILLER RD STE A
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1599
Practice Address - Country:US
Practice Address - Phone:810-630-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010887571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical