Provider Demographics
NPI:1295821916
Name:LICHI, DONALD ALLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ALLEN
Last Name:LICHI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 PARK RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1425
Mailing Address - Country:US
Mailing Address - Phone:330-686-9324
Mailing Address - Fax:
Practice Address - Street 1:545 PARK RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:MUNROE FALLS
Practice Address - State:OH
Practice Address - Zip Code:44262-1425
Practice Address - Country:US
Practice Address - Phone:330-686-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4867103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist