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General NPI Number Information
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NPI Number | 1760207799
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Entity Type | Organization
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Legal Business Name | LILAH CLEVEY PLLC
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/17/2024
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Provider Practice Location Address
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Address Line | 2202 MITCHELL PARK DR STE 2B
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City | PETOSKEY
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State | MI
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Zip | 49770-8897
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Country | US
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Telephone | 248-231-1394
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Fax |
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Provider Business Mailing Address
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Address Line | 521 JENNINGS AVE
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City | PETOSKEY
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State | MI
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Zip | 49770-3105
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Country | US
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Telephone | 248-231-1394
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | LILAH CLEVEY
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Credential | PHD
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Telephone | 248-231-1394
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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 |
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License Number State |
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