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Individual

LISE A SHIRTZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
36975 UTICA RD, SUITE 103, CLINTON TOWNSHIP, MI 48036-1685
(586) 226-3440
(586) 226-3740
Mailing address
36975 UTICA RD, SUITE 103, CLINTON TOWNSHIP, MI 48036-1685
(586) 226-3440
(586) 226-3672

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301011642
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
450002000
POLICY #
Enumeration date
12/05/2006
Last updated
11/17/2011
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