Healthcare Provider Details

I. General information

NPI: 1760695548
Provider Name (Legal Business Name): DIANE NELLES LINDSAY ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 19 MILE RD
CLINTON TOWNSHIP MI
48038-1103
US

IV. Provider business mailing address

2345 WINKLEMAN DR
WATERFORD MI
48329-4449
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-8919
  • Fax:
Mailing address:
  • Phone: 248-674-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301003929
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number6301003929
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: