Individual
LISA MARIE MAKUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3770 GLENKERRY CT, PORTAGE, MI 49024-0700
(269) 329-2887
(269) 329-2805
Mailing address
61 COMMERCE AVE SW, GRAND RAPIDS, MI 49503-4124
(616) 940-0660
(616) 940-1965
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301010149
MI
Other
Enumeration date
04/08/2009
Last updated
04/13/2009
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