Provider Demographics
NPI:1043425440
Name:LEE, MICHELLE VAN ETTEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:VAN ETTEN
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MICHIGAN PSYCHOLOGICAL CLINIC
Mailing Address - Street 2:500 E. WASHINGTON ST. SUITE 100
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-9314
Mailing Address - Country:US
Mailing Address - Phone:734-764-3471
Mailing Address - Fax:734-764-8128
Practice Address - Street 1:UNIVERSITY OF MICHIGAN PSYCHOLOGICAL CLINIC
Practice Address - Street 2:500 E. WASHINGTON ST. SUITE 100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1043
Practice Address - Country:US
Practice Address - Phone:734-764-3471
Practice Address - Fax:734-764-8128
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2023-11-17
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Provider Licenses
StateLicense IDTaxonomies
MI6301010569103TC0700X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical