=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699408864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LISA BARBER, LPC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2022
-----------------------------------------------------
Last Update Date | 07/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2442 E MAPLE AVE STE 204
-----------------------------------------------------
City | GRAND BLANC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48507-4491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-266-1222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2442 E MAPLE AVE STE 204
-----------------------------------------------------
City | GRAND BLANC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48507-4491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-266-1222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL/OWNER
-----------------------------------------------------
Name | LISA A BARBER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 248-266-1222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------