| Lpa | |
|
2001 Abbot Rd East Lansing MI 48823-1400 | |
| (517) 337-6545 | |
| (517) 337-3010 |
| Full Name | Lpa |
|---|---|
| Speciality | Clinic/Center |
| Location | 2001 Abbot Rd, East Lansing, Michigan |
| Authorized Official Name and Position | Jennifer Carter (BILLING SUPERVISOR) |
| Authorized Official Contact | 5173376545 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lpa 2001 Abbot Rd East Lansing MI 48823-1400 Ph: (517) 337-6545 | Lpa 2001 Abbot Rd East Lansing MI 48823-1400 Ph: (517) 337-6545 |
| NPI Number | 1184773368 |
|---|---|
| Provider Enumeration Date | 01/09/2007 |
| Last Update Date | 02/03/2021 |
| Certification Date | 02/03/2021 |
| Medicare PECOS PAC ID | 8426048323 |
|---|---|
| Medicare Enrollment ID | O20040513000765 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184773368 | NPI | - | NPPES |
| 037537 | Other | MI | VALUE OPTIONS PIN # |
| 7509108750 | Other | MI | BLUE CROSS FACILITY # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (Michigan) | Primary |
| Provider Name | Mark J Cannizzaro |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1144373812 PECOS PAC ID: 1153306014 Enrollment ID: I20051024000509 |
| Provider Name | James R Engelkes |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518016005 PECOS PAC ID: 4486644390 Enrollment ID: I20111108000158 |
| Provider Name | Gene D Harris |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639220627 PECOS PAC ID: 9537322920 Enrollment ID: I20120522001283 |
| Provider Name | Jessie Maynard |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710126750 PECOS PAC ID: 3072899244 Enrollment ID: I20170425000701 |
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