Provider Demographics
NPI:1184765232
Name:RUDOLPH, LAURIE SCHEID (MA, LPC, NCC, CAAC)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:SCHEID
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:MA, LPC, NCC, CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5937 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9101
Mailing Address - Country:US
Mailing Address - Phone:269-929-6964
Mailing Address - Fax:
Practice Address - Street 1:5985 W MAIN ST
Practice Address - Street 2:SUITE 809
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8708
Practice Address - Country:US
Practice Address - Phone:269-929-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009641101YP2500X
MIC-00572101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401009641OtherPROF COUNSEL LL
MI201686OtherINTERNATIONAL CERTIFICATION AND RECIPROCITY CONSORTIUM
MI208703OtherNATIONAL BOARD FOR CERTIFIED COUNSELORS INC
MIC-00572OtherMICHIGAN CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS