Healthcare Provider Details

I. General information

NPI: 1831513027
Provider Name (Legal Business Name): LISA BURG PSY.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 LOCUST ST S
CANAL FULTON OH
44614-9389
US

IV. Provider business mailing address

2309 LOCUST ST S
CANAL FULTON OH
44614-9389
US

V. Phone/Fax

Practice location:
  • Phone: 330-854-2291
  • Fax:
Mailing address:
  • Phone: 330-854-2291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.02287
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH3151584
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: