Healthcare Provider Details

I. General information

NPI: 1104735521
Provider Name (Legal Business Name): LIZA BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3582 REED RD
COLUMBUS OH
43221-1371
US

IV. Provider business mailing address

3582 REED RD
COLUMBUS OH
43221-1371
US

V. Phone/Fax

Practice location:
  • Phone: 419-296-2678
  • Fax:
Mailing address:
  • Phone: 419-296-2678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01044
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: