Change of Name or Address/Duplicate License Request for Health Licensees

To change your name and/or address for one of the following professions please visit


Behavior Analyst/Assistant Behavior Analyst

Dentists and dental related professions




Osteopathic Medicine

Pharmacy and pharmacy related professions


Physician’s Assistant

Veterinary Medicine related veterinary professions


You will have the option of paying for a new license to be issued with updated information as part of the process.


For all other health professions you must submit a request to change your name in writing.  To change your address, for a profession not listed above, you must either submit in writing or via the Internet at   If you require a new license to be issued with the new information you can request and pay for a duplicate license with a credit card. A new license is not issued automatically.


You can also complete the Data Change/Duplicate License Request Form


Fax to 517-335-2044 or email to  (only if new license is not being requested) or

Mail the form to LARA/BPL/Licensing Division, PO Box 30670, Lansing MI 48909.

Include $10 fee if new license is being requested.