Philip Charles Liethen, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

3063 Issued in MI

Practice address

2616 Whitney PL
Fort Gratiot, MI 48059-3952

Phone

(586) 246-5746

NPI assigned

Dec 14, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Blue Water Mental Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fort Gratiot, MI
  • NPI 1457305419
  NPD (past)

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1689659526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2616 WHITNEY PL",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593952",
            "telephone_number": "586-246-5746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2616 WHITNEY PL",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593952",
            "telephone_number": "586-246-5746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIETHEN",
        "first_name": "PHILIP",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-14",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MI",
            "license": "3063",
            "primary": true
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "WI",
            "license": "2082",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna Lynn Lester
• Jenna R Letzgus
• Jessica Ryann Lewis
• Lauren E Lewis
• Linda A Liethen, LLP
• Lighthouse Family Medicine, PLLC
• Lincare Inc
• Live Big & Loud LLC
• Swinder Logue
• Skylar London

• Clinical Neuropsychologist in Fort Gratiot, MI
• Providers in Fort Gratiot, MI by specialty
• Clinical Neuropsychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.