Healthcare Provider Details

I. General information

NPI: 1043425440
Provider Name (Legal Business Name): MICHELLE VAN ETTEN LEE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 EL CAMINO REAL STE 120
MENLO PARK CA
94025-4884
US

IV. Provider business mailing address

UNIVERSITY OF MICHIGAN PSYCHOLOGICAL CLINIC 500 E. WASHINGTON ST. SUITE 100
ANN ARBOR MI
48109-9314
US

V. Phone/Fax

Practice location:
  • Phone: 650-204-1246
  • Fax:
Mailing address:
  • Phone: 734-764-3471
  • Fax: 734-764-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301010569
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301010569
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: