Provider Demographics
NPI:1184248759
Name:BODY-BASED PSYCHOTHERAPY OF METRO DETROIT, PLLC
Entity type:Organization
Organization Name:BODY-BASED PSYCHOTHERAPY OF METRO DETROIT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOMBARDO
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:248-561-6208
Mailing Address - Street 1:2239 CUMMINGS AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1081
Mailing Address - Country:US
Mailing Address - Phone:248-561-6208
Mailing Address - Fax:
Practice Address - Street 1:215 ANN ARBOR RD W STE 206
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2251
Practice Address - Country:US
Practice Address - Phone:248-561-6208
Practice Address - Fax:248-398-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-30
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty