DR. MICHAEL LEE SERETNY PHD, HSPP

Clinical Neuropsychologist

West Lafayette, Indiana

Provider NPI: 1235139049

Provider Information:
DR. MICHAEL LEE SERETNY PHD, HSPP
Gender: M
Sole Proprietor


Practice Location:
1203 TRACE 12  WEST LAFAYETTE, IN 47906 US
Tel: 765-430-4049  Fax: --

Business Mailing Address:
1203 TRACE 12  WEST LAFAYETTE, IN 47906 US
Tel: 765-430-4049  Fax: --

Entity Type: Individual

Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	103G00000X	Behavioral Health & Social Service Providers Clinical Neuropsychologist	IN	20040537A

Other Provider Identifiers:

Issuer	Number	State	Type
STATE LICENSE	20040537A	IN	01

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin

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