Healthcare Provider Details

I. General information

NPI: 1376327486
Provider Name (Legal Business Name): LISA LYNETTE SIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3618 W MARKET ST STE 15
FAIRLAWN OH
44333-2425
US

IV. Provider business mailing address

3618 W MARKET ST STE 15
FAIRLAWN OH
44333-2425
US

V. Phone/Fax

Practice location:
  • Phone: 234-466-0445
  • Fax:
Mailing address:
  • Phone: 234-466-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: