Provider Demographics
NPI:1609990092
Name:NOLAN, DAN R (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:R
Last Name:NOLAN
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 1:4090 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4528
Mailing Address - Country:US
Mailing Address - Phone:734-761-9368
Mailing Address - Fax:
Practice Address - Street 1:8110 JACKSON RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9597
Practice Address - Country:US
Practice Address - Phone:734-426-0032
Practice Address - Fax:734-426-0034
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006822103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical