Individual
LINDA A LIETHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLP
Contact information
Practice address
1501 KRAFFT RD, FORT GRATIOT, MI 48059-3565
(810) 985-5125
(810) 985-5127
Mailing address
1501 KRAFFT RD, FORT GRATIOT, MI 48059-3565
(810) 985-5125
(810) 985-5127
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301003381
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0G46345
BLUE WATER COUNSELING PTAN ID
MI
Enumeration date
07/26/2006
Last updated
10/29/2015
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