Provider Demographics
NPI:1275968257
Name:LEIBERT, LYANNA MARIE (MED, EDS)
Entity Type:Individual
Prefix:
First Name:LYANNA
Middle Name:MARIE
Last Name:LEIBERT
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S LIVERNOIS RD STE C12
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2582
Mailing Address - Country:US
Mailing Address - Phone:248-605-1860
Mailing Address - Fax:248-659-1543
Practice Address - Street 1:455 S LIVERNOIS RD STE C12
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2582
Practice Address - Country:US
Practice Address - Phone:248-605-1860
Practice Address - Fax:248-659-1543
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011071101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional