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General NPI Number Information
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NPI Number | 1326590977
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Entity Type | Individual
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Provider Name | LISANNE GREY
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Gender | Female
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 2940 INLAND EMPIRE BLVD
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City | ONTARIO
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State | CA
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Zip | 91764-4898
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Country | US
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Telephone | 909-458-1376
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Fax | 909-944-1059
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Provider Business Mailing Address
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Address Line | 2940 INLAND EMPIRE BLVD
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City | ONTARIO
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State | CA
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Zip | 91764-4898
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Country | US
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Telephone | 909-732-6932
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Fax | 909-944-1059
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 9795
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License Number State | CA
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