Basic Information
Provider Information | |||||||||
NPI: | 1508204850 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LAPS PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2790 PARKWICK CT | ||||||||
Address2: | SUITE 101 | ||||||||
City: | WEST BLOOMFIELD | ||||||||
State: | MI | ||||||||
PostalCode: | 483244105 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2483632850 | ||||||||
FaxNumber: | 8003806809 | ||||||||
Practice Location | |||||||||
Address1: | 8898 COMMERCE RD | ||||||||
Address2: | SUITE 3A | ||||||||
City: | COMMERCE TWP | ||||||||
State: | MI | ||||||||
PostalCode: | 483824485 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2483632850 | ||||||||
FaxNumber: | 8003806809 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/10/2013 | ||||||||
LastUpdateDate: | 06/10/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FERSHTMAN | ||||||||
AuthorizedOfficialFirstName: | LINDA | ||||||||
AuthorizedOfficialMiddleName: | F | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
AuthorizedOfficialTelephone: | 2483632850 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | S.PSY.S, L.L.P. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.