Provider Demographics
NPI:1053347500
Name:MILAN, LORI DIANA (PHD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:DIANA
Last Name:MILAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17215 ROLLING DUNES DR
Mailing Address - Street 2:
Mailing Address - City:WEST OLIVE
Mailing Address - State:MI
Mailing Address - Zip Code:49460-9512
Mailing Address - Country:US
Mailing Address - Phone:616-502-9064
Mailing Address - Fax:616-844-5099
Practice Address - Street 1:1325 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1813
Practice Address - Country:US
Practice Address - Phone:231-737-8446
Practice Address - Fax:231-737-0510
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist