Healthcare Provider Details

I. General information

NPI: 1568005353
Provider Name (Legal Business Name): NANCY C LIEBLER PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 12/23/2023
Certification Date: 12/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 HARMON ST APT 290
BIRMINGHAM MI
48009-1367
US

IV. Provider business mailing address

280 HARMON ST APT 290
BIRMINGHAM MI
48009-1367
US

V. Phone/Fax

Practice location:
  • Phone: 248-840-0519
  • Fax: 248-569-9410
Mailing address:
  • Phone: 248-840-0519
  • Fax: 248-569-9410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NANCY C LIEBLER
Title or Position: OWNER
Credential: PHD
Phone: 248-840-0519