Provider Demographics
NPI:1386785103
Name:LES, BERNARD M III (PHD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:M
Last Name:LES
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N OLD WOODWARD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-3855
Mailing Address - Country:US
Mailing Address - Phone:248-310-2346
Mailing Address - Fax:734-261-8854
Practice Address - Street 1:620 N OLD WOODWARD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-3855
Practice Address - Country:US
Practice Address - Phone:248-310-2346
Practice Address - Fax:734-261-8854
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012729103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical