Provider Demographics
NPI:1326402769
Name:PATRICIA LYMAN, PH.D., PLC
Entity Type:Organization
Organization Name:PATRICIA LYMAN, PH.D., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYMAN
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:269-343-2800
Mailing Address - Street 1:5220 LOVERS LN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1599
Mailing Address - Country:US
Mailing Address - Phone:269-343-2800
Mailing Address - Fax:
Practice Address - Street 1:5220 LOVERS LN
Practice Address - Street 2:SUITE 120
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1599
Practice Address - Country:US
Practice Address - Phone:269-343-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006637103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C94564Medicare UPIN