Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6301010569 | MI |
NPI | 1043425440 |
---|---|
Provider Name | Dr. Michelle Van Etten Lee |
First Address | Ann Arbor, MI 48108-9314 |
Second Address | Ann Arbor, MI 48109-1043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 08/07/2007 |