Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY 60460149 | WA |
N | 103T00000X | Psychologist | PY 60460149 | WA |
Y | 103G00000X | Clinical Psychologist | 6301017730 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301017730 | MI |
NPI | 1013276138 |
---|---|
Provider Name | Lisa M Valentine |
First Address | Ann Arbor, MI 48105-2303 |
Second Address | Ann Arbor, MI 48105-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2012 |
Last Update Date | 18/12/2019 |