Healthcare Provider Details

I. General information

NPI: 1013904796
Provider Name (Legal Business Name): LISA METLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 MEADOWBROOK RD STE 150
NOVI MI
48375-1880
US

IV. Provider business mailing address

25500 MEADOWBROOK RD STE 150
NOVI MI
48375-1880
US

V. Phone/Fax

Practice location:
  • Phone: 248-784-3667
  • Fax: 248-869-3982
Mailing address:
  • Phone: 248-784-3667
  • Fax: 248-869-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4301008070
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: