Provider Demographics
NPI:1558109595
Name:LAPHAM, ZOE (MS)
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:LAPHAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 BROAD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-1018
Mailing Address - Country:US
Mailing Address - Phone:810-874-7668
Mailing Address - Fax:
Practice Address - Street 1:3249 BROAD ST STE 1
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-1018
Practice Address - Country:US
Practice Address - Phone:810-874-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009957103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical