| Lisa Mcmichael | |
|
608 W Glen Arbor Way Bloomington IN 47403-4537 | |
| (812) 345-0492 | |
| Not Available |
| Full Name | Lisa Mcmichael |
|---|---|
| Speciality | Psychologist |
| Location | 608 W Glen Arbor Way, Bloomington, Indiana |
| Authorized Official Name and Position | Lisa Ann Mcmichael (PSYCHOLOGIST) |
| Authorized Official Contact | 8123450492 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Mcmichael 608 W Glen Arbor Way Bloomington IN 47403-4537 Ph: (812) 345-0492 | Lisa Mcmichael 608 W Glen Arbor Way Bloomington IN 47403-4537 Ph: (812) 345-0492 |
| NPI Number | 1174223523 |
|---|---|
| Provider Enumeration Date | 03/06/2023 |
| Last Update Date | 08/16/2023 |
| Certification Date | 08/16/2023 |
| Medicare PECOS PAC ID | 4789034299 |
|---|---|
| Medicare Enrollment ID | O20231226001320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174223523 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lisa A Mcmichael |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609937135 PECOS PAC ID: 5698723757 Enrollment ID: I20200707003045 |
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