Provider Demographics
NPI:1851307805
Name:LICHTMAN, LORI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:LICHTMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 OAK VALLEY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9118
Mailing Address - Country:US
Mailing Address - Phone:734-995-5181
Mailing Address - Fax:734-995-9011
Practice Address - Street 1:2395 OAK VALLEY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9118
Practice Address - Country:US
Practice Address - Phone:734-995-5181
Practice Address - Fax:734-995-9011
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010154103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680H148340OtherBCBS OF MI
MI680H107900OtherBCBS OF MI
MI680H118950OtherBCBS OF MI
MI680H107900OtherBCBS OF MI
MIP85397Medicare UPIN