Organization
LAKESHORE PSYCHOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI DIANA MILAN PH.D. (SOLE MEMBER)
(616) 502-9064
Entity
Organization
Contact information
Practice address
1325 E SHERMAN BLVD, MUSKEGON, MI 49444-1813
(231) 737-8446
(231) 737-0510
Mailing address
17215 ROLLING DUNES DR, WEST OLIVE, MI 49460-9512
(616) 502-9064
(616) 844-5099
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6301009500
MI
Other
Enumeration date
01/30/2008
Last updated
01/30/2008
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