Basic Information
| Provider Information | |||||||||
| NPI: | 1750859294 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAGARDE | ||||||||
| FirstName: | LEONARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | T.L.L.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5946 BATTLE CREEK RD | ||||||||
| Address2: | |||||||||
| City: | OLIVET | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490769470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347034621 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1310 TURNER ST STE A | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489064373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5175744197 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2018 | ||||||||
| LastUpdateDate: | 11/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301017706 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.