Active NPI
Laurie A Lundblad, PSYD
- Clinical Child & Adolescent Psychologist
- Plymouth, MI
National Provider Identifier
1477893220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 6301013693
- Practice address
- 9357 General Dr
Suite 101
Plymouth, MI 48170-4662 - Phone
- (734) 454-0866
- Fax
- (734) 454-1744
- NPI assigned
- Feb 14, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 6301013693 | MI | Primary |
Addresses
Primary practice location
9357 General Dr
Suite 101
Plymouth, MI 48170-4662
Mailing address
9357 General Dr
Suite 101
Plymouth, MI 48170-4662
Phone (734) 454-0866
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301013693 | MI | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1360800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360800000000",
"number": "1477893220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9357 GENERAL DR",
"address_2": "SUITE 101",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481704662",
"telephone_number": "734-454-0866",
"fax_number": "734-454-1744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9357 GENERAL DR",
"address_2": "SUITE 101",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481704662",
"telephone_number": "734-454-0866",
"fax_number": "734-454-1744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNDBLAD",
"first_name": "LAURIE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-02-14",
"last_updated": "2013-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MI",
"license": "6301013693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.