Provider Demographics
NPI:1528113826
Name:LEHKY, BRIAN B (PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:B
Last Name:LEHKY
Suffix:
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 1:2202 MITCHELL PARK DR
Mailing Address - Street 2:UNIT 5
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8897
Mailing Address - Country:US
Mailing Address - Phone:231-439-5299
Mailing Address - Fax:231-439-5272
Practice Address - Street 1:2202 MITCHELL PARK DR
Practice Address - Street 2:UNIT 5
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8897
Practice Address - Country:US
Practice Address - Phone:231-439-5299
Practice Address - Fax:231-439-5272
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2015-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010367103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM97520Medicare ID - Type Unspecified
MIS42861Medicare UPIN