Provider Demographics
NPI:1508168519
Name:UFER, LISA ANN GORMAN (PHD LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN GORMAN
Last Name:UFER
Suffix:
Gender:F
Credentials:PHD LMFT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:GORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 S MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2122
Mailing Address - Country:US
Mailing Address - Phone:734-224-3822
Mailing Address - Fax:888-881-8415
Practice Address - Street 1:214 S MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2122
Practice Address - Country:US
Practice Address - Phone:734-224-3822
Practice Address - Fax:888-881-8415
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006453106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist