Provider Demographics
NPI:1528632536
Name:CLEVEY, LILAH
Entity type:Individual
Prefix:
First Name:LILAH
Middle Name:
Last Name:CLEVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 FERRIS ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5302
Mailing Address - Country:US
Mailing Address - Phone:248-231-1394
Mailing Address - Fax:
Practice Address - Street 1:5340 PLYMOUTH RD STE 202
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9341
Practice Address - Country:US
Practice Address - Phone:734-369-6084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362002612103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical