Provider Demographics
NPI:1013920636
Name:HEALY, LORI A (MA, LLP, CAADC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:HEALY
Suffix:
Gender:F
Credentials:MA, LLP, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14223 S FRANCISCO RD
Mailing Address - Street 2:
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-9815
Mailing Address - Country:US
Mailing Address - Phone:810-204-5731
Mailing Address - Fax:
Practice Address - Street 1:14223 S FRANCISCO RD
Practice Address - Street 2:
Practice Address - City:GRASS LAKE
Practice Address - State:MI
Practice Address - Zip Code:49240-9815
Practice Address - Country:US
Practice Address - Phone:810-204-5731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010410101YM0800X, 103T00000X
MI6361004537103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910475OtherBCBS PIN