Healthcare Provider Details

I. General information

NPI: 1396822631
Provider Name (Legal Business Name): LISA MARIE BORCHERT-HRIVNAK LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 S COURT ST SUITE 5
MEDINA OH
44256-2259
US

IV. Provider business mailing address

230 S COURT ST SUITE 5
MEDINA OH
44256-2259
US

V. Phone/Fax

Practice location:
  • Phone: 330-723-7977
  • Fax: 330-725-5177
Mailing address:
  • Phone: 330-723-7977
  • Fax: 330-725-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE3428
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: