Provider Demographics
NPI:1578664694
Name:LOYNES, JACK LEROY (PHD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:LEROY
Last Name:LOYNES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4572 S HAGADORN RD
Mailing Address - Street 2:SUITE 2A EAST
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5385
Mailing Address - Country:US
Mailing Address - Phone:517-349-8388
Mailing Address - Fax:517-349-1560
Practice Address - Street 1:4572 S HAGADORN RD
Practice Address - Street 2:SUITE 2A EAST
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5385
Practice Address - Country:US
Practice Address - Phone:517-349-8388
Practice Address - Fax:517-349-1560
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005922103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680C346250Other2
MI0C34625Medicare PIN