Individual
DR. LILLY GLANCY JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
3901 BEAUBIEN ST, DETROIT, MI 48201-2119
(313) 832-8480
Mailing address
125 MARTELL DR, BLOOMFIELD HILLS, MI 48304-3447
(248) 835-4749
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301016104
MI
Other
Enumeration date
06/29/2015
Last updated
06/29/2015
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