Provider Demographics
NPI:1669423844
Name:LAZAR PSYCHOLOGICAL SERVICES, LTD
Entity type:Organization
Organization Name:LAZAR PSYCHOLOGICAL SERVICES, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:269-962-2722
Mailing Address - Street 1:211 CAPITAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3926
Mailing Address - Country:US
Mailing Address - Phone:269-962-2722
Mailing Address - Fax:269-964-8484
Practice Address - Street 1:211 CAPITAL AVE NE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017
Practice Address - Country:US
Practice Address - Phone:269-962-2722
Practice Address - Fax:269-964-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68-0H010630OtherBCBSM
MIR83879Medicare UPIN
MI68-0H010630OtherBCBSM