Provider Demographics
NPI:1821017948
Name:BELL, LISA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:BELL
Suffix:
Gender:F
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:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48805-0344
Mailing Address - Country:US
Mailing Address - Phone:517-203-5056
Mailing Address - Fax:517-203-5057
Practice Address - Street 1:936 DELAWARE AVE STE 403
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1861
Practice Address - Country:US
Practice Address - Phone:517-381-1062
Practice Address - Fax:517-203-5057
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022126OtherPSYCHOLOGY LICENSE NY
MI383619278OtherFEDERAL TAX ID
MI6301009942OtherPSYCHOLOGY LICENCE #
MI680C347210OtherBC/BS
MI6301009942OtherPSYCHOLOGY LICENCE #