Healthcare Provider Details

I. General information

NPI: 1467924134
Provider Name (Legal Business Name): LISA MARIE PIETRAS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 RIVER RD
MAUMEE OH
43537
US

IV. Provider business mailing address

2821 WANAMAKER DR
TOLEDO OH
43613
US

V. Phone/Fax

Practice location:
  • Phone: 419-720-3052
  • Fax: 417-893-0475
Mailing address:
  • Phone: 407-453-3908
  • Fax: 419-893-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1902200
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: