Provider Demographics
NPI:1548452451
Name:BACH, LEE G (PHD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:G
Last Name:BACH
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 1:27620 FARMINGTON ROAD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48344
Mailing Address - Country:US
Mailing Address - Phone:248-767-1104
Mailing Address - Fax:
Practice Address - Street 1:27620 FARMINGTON ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48344
Practice Address - Country:US
Practice Address - Phone:248-767-1104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008278103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist