License holder summary

LISA MARIE PROVOST is a Psychology - Master's Ltd. Psychologist licensed to practice in Michigan. This medical licensee license is current. The license was granted 04/11/2000 and expired on 08/31/2016.

Department of Licensing and Regulatory Affairs

Board of Medicine

LISA MARIE PROVOST
Psychology - Master's Ltd. Psychologist
License number
6301010883
Date granted
04/11/2000
Date expires
08/31/2016
Class
Psychology - Master's Ltd. Psychologist
Status
Active
Address
michiganmedical.net
ID 39324896
LAST UPDATED 2024-01-31 08:57:54 UTC

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