Provider Demographics
NPI:1013904796
Name:METLER, LISA (PHD)
Entity Type:Individual
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First Name:LISA
Middle Name:
Last Name:METLER
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:29275 NORTHWESTERN HWY
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1044
Mailing Address - Country:US
Mailing Address - Phone:877-784-3667
Mailing Address - Fax:248-784-3743
Practice Address - Street 1:46325 W. TWELVE MILE RD
Practice Address - Street 2:STE. 100
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:877-784-3667
Practice Address - Fax:248-869-3982
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2010-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301008070103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Q26462Medicare PIN
MIR66879Medicare UPIN