Provider Demographics
NPI:1184873929
Name:STULL, LINDSAY DIANE (LLP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:DIANE
Last Name:STULL
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:DIANE
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30016 COUNTY ROAD 354
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:MI
Mailing Address - Zip Code:49065-8615
Mailing Address - Country:US
Mailing Address - Phone:269-806-4582
Mailing Address - Fax:
Practice Address - Street 1:801 HAZEN ST
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-2008
Practice Address - Country:US
Practice Address - Phone:269-655-3396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013948103TC0700X
MI6361003581103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical