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


Athletic Trainers
Behavior Analyst/Assistant Behavior Analyst
Dentists and dental related professions
Marriage and Family Therapists
Massage Therapists
Osteopathic Medicine
Pharmacy and pharmacy related professions
Physician's Assistant
Speech Language Pathology
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.