NPIMap

Individual provider Active NPI

Michelle Van Etten Lee, PH.D.

  • Cognitive & Behavioral Psychologist
  • Ann Arbor, MI
National Provider Identifier
1043425440
Registry record updated Nov 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
License
6301010569 Issued in MI
Practice address
University of Michigan Psychological Clinic
500 E. Washington St. Suite 100
Ann Arbor, MI 48109-1043
Phone
(734) 764-3471
Fax
(734) 764-8128
NPI assigned
May 11, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6301010569 MI
Cognitive & Behavioral Psychologist 103TB0200X 6301010569 MI Primary

Addresses

Primary practice location

University of Michigan Psychological Clinic
500 E. Washington St. Suite 100
Ann Arbor, MI 48109-1043

Mailing address

University of Michigan Psychological Clinic
500 E. Washington St. Suite 100
Ann Arbor, MI 48109-9314
Phone (734) 764-3471

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

LicenseStateTypeSpecialty
6301010569MIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan-Psychological Clinic Past Accepting new patients
California Psychology Center Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1043425440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF MICHIGAN PSYCHOLOGICAL CLINIC",
            "address_2": "500 E. WASHINGTON ST. SUITE 100",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481099314",
            "telephone_number": "734-764-3471",
            "fax_number": "734-764-8128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF MICHIGAN PSYCHOLOGICAL CLINIC",
            "address_2": "500 E. WASHINGTON ST. SUITE 100",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481091043",
            "telephone_number": "734-764-3471",
            "fax_number": "734-764-8128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "MICHELLE",
        "middle_name": "VAN ETTEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-11",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301010569",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MI",
            "license": "6301010569",
            "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 Nov 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.