Provider Demographics
NPI:1457527871
Name:MICHAEL, LAWRENCE ALBERT (LPC)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:ALBERT
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:LAWRENCE
Other - Middle Name:ALBERT
Other - Last Name:MICHAEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1215 FREDERICKTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-8583
Mailing Address - Country:US
Mailing Address - Phone:573-747-6434
Mailing Address - Fax:
Practice Address - Street 1:1215 FREDERICKTOWN AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-8583
Practice Address - Country:US
Practice Address - Phone:573-747-6434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007011916101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health