1275751406 NPI number — MRS. BAMBI A LAHAIE LMSW

Table of content: MRS. BAMBI A LAHAIE LMSW (NPI 1275751406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275751406 NPI number — MRS. BAMBI A LAHAIE LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAHAIE
Provider First Name:
BAMBI
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAFER
Provider Other First Name:
BAMBI
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275751406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 E SOUTHERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-726-3582
Provider Business Mailing Address Fax Number:
231-722-6933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 E SOUTHERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-726-3582
Provider Business Practice Location Address Fax Number:
231-722-6933
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801083993 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BL083993 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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