Provider Demographics
NPI:1861633570
Name:LAFLAME, TERRY LYNN (TLL)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:LAFLAME
Suffix:
Gender:F
Credentials:TLL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-9293
Mailing Address - Country:US
Mailing Address - Phone:989-673-3191
Mailing Address - Fax:989-673-0064
Practice Address - Street 1:2000 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9293
Practice Address - Country:US
Practice Address - Phone:989-673-3191
Practice Address - Fax:989-673-0064
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013890103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1758845Medicaid
MI234025Medicare PIN