Provider Demographics
NPI:1801195102
Name:BRIAN B LEHKY PHD PC
Entity Type:Organization
Organization Name:BRIAN B LEHKY PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST; OWNER; PRESI
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEHKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:231-439-5299
Mailing Address - Street 1:2202 MITCHELL PARK DR
Mailing Address - Street 2:UNIT 5
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8897
Mailing Address - Country:US
Mailing Address - Phone:231-439-5299
Mailing Address - Fax:231-439-5272
Practice Address - Street 1:2202 MITCHELL PARK DR
Practice Address - Street 2:UNIT 5
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8897
Practice Address - Country:US
Practice Address - Phone:231-439-5299
Practice Address - Fax:231-439-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010367103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM97520OtherMEDICARE ID - TYPE UNSPECIFIED
MIOM97520OtherMEDICARE ID - TYPE UNSPECIFIED