Healthcare Provider Details

I. General information

NPI: 1659848752
Provider Name (Legal Business Name): DR. LYZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E. WALNUT ST.
NAZARETH PA
18064-2708
US

IV. Provider business mailing address

15 E. WALNUT ST.
NAZARETH PA
18064-2708
US

V. Phone/Fax

Practice location:
  • Phone: 610-365-5042
  • Fax: 610-365-5044
Mailing address:
  • Phone: 610-365-5042
  • Fax: 610-365-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH DEBOER KREIDER
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D
Phone: 610-365-5042