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General NPI Number Information
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NPI Number | 1467950766
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Entity Type | Individual
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Provider Name | HOLLY LISTER PHD
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Gender | Female
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 05/02/2024
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Provider Practice Location Address
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Address Line | 201 3RD ST STE 200
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City | BELLEVILLE
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State | MI
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Zip | 48111-2605
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Country | US
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Telephone | 734-697-9059
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 E JEFFERSON AVE APT 221
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City | DETROIT
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State | MI
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Zip | 48207-4398
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301016769
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00616900
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License Number State | NJ
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