Provider Demographics
NPI:1104063577
Name:THEODOROU-EHRLICH, LENA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LENA
Middle Name:
Last Name:THEODOROU-EHRLICH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E WILLIAM ST APT 22C
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2427
Mailing Address - Country:US
Mailing Address - Phone:734-662-7570
Mailing Address - Fax:734-663-6264
Practice Address - Street 1:555 E WILLIAM ST APT 22C
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2427
Practice Address - Country:US
Practice Address - Phone:734-662-7570
Practice Address - Fax:734-663-6264
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006437103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical