Provider Demographics
NPI:1649245655
Name:LYMAN, PATRICIA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:LYMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:LYMAN
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006637103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C94564Medicare UPIN