Healthcare Provider Details

I. General information

NPI: 1639712920
Provider Name (Legal Business Name): NANCY CULLEN LIEBLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2019
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 Code103TF0000X
TaxonomyFamily Psychologist
License Number6301995515
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: