Healthcare Provider Details

I. General information

NPI: 1932182128
Provider Name (Legal Business Name): LISA JEWELL MICHAEL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA A JEWELL PH.D.

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22251 STATE ROUTE 2
ARCHBOLD OH
43502-9452
US

IV. Provider business mailing address

314 N PLEASANT ST
MONTPELIER OH
43543-1150
US

V. Phone/Fax

Practice location:
  • Phone: 419-445-1552
  • Fax: 419-445-1401
Mailing address:
  • Phone: 419-551-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6062
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.6062
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: