Basic Information
| Provider Information | |||||||||
| NPI: | 1962719732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUEBLER | ||||||||
| FirstName: | LANCE | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., T.L.L.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15535 LAKESIDE VILLAGE DR APT 306 | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480386019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342621492 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 44899 CENTRE CT STE 102 | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480385510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867921654 | ||||||||
| FaxNumber: | 5867921656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2010 | ||||||||
| LastUpdateDate: | 09/01/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | L1845892 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.