Active NPI
Lisa M Valentine, PHD
- Clinical Psychologist
- Ann Arbor, MI
National Provider Identifier
1013276138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301017730
- Practice address
- 2215 Fuller Rd
Ann Arbor, MI 48105-2303 - Phone
- (734) 796-7100
- NPI assigned
- May 9, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY 60460149 | WA | |
| Clinical Psychologist | 103TC0700X | 6301017730 | MI | Primary |
Addresses
Primary practice location
2215 Fuller Rd
Ann Arbor, MI 48105-2303
Mailing address
2215 Fuller Rd
Ann Arbor, MI 48105-2303
Phone (734) 796-7100
Other practice location 1
5th Medical Group
194 Missile Ave
Minot AFB, ND 58705
Phone (701) 723-5527
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY 60460149 | WA | MD | Psychologist |
| 6301017730 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576627200000",
"number": "1013276138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2215 FULLER RD",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481052303",
"telephone_number": "734-796-7100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2215 FULLER RD",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481052303",
"telephone_number": "734-796-7100"
}
],
"practiceLocations": [
{
"address_1": "5th Medical Group",
"address_2": "194 Missile Ave",
"address_purpose": "LOCATION",
"city": "Minot AFB",
"state": "ND",
"postal_code": "58705",
"country_code": "US",
"telephone_number": "701-723-5527",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VALENTINE",
"first_name": "LISA",
"middle_name": "M",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-09",
"last_updated": "2019-12-18",
"certification_date": "2019-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "PY 60460149",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301017730",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.