Healthcare Provider Details

I. General information

NPI: 1265581458
Provider Name (Legal Business Name): LEWIS EDWARD OKUN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S HURON PKWY STE 3A
ANN ARBOR MI
48104-5133
US

IV. Provider business mailing address

2301 S HURON PKWY STE 3A
ANN ARBOR MI
48104-5133
US

V. Phone/Fax

Practice location:
  • Phone: 734-223-1248
  • Fax: 888-403-0285
Mailing address:
  • Phone: 734-223-1248
  • Fax: 888-403-0285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301002860
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: