Provider Demographics
NPI:1962719732
Name:KUEBLER, LANCE RICHARD (MS, TLLP)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:RICHARD
Last Name:KUEBLER
Suffix:
Gender:M
Credentials:MS, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15535 LAKESIDE VILLAGE DR APT 306
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6019
Mailing Address - Country:US
Mailing Address - Phone:734-262-1492
Mailing Address - Fax:
Practice Address - Street 1:44899 CENTRE CT STE 102
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5510
Practice Address - Country:US
Practice Address - Phone:586-792-1654
Practice Address - Fax:586-792-1656
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1845892103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist