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General NPI Number Information
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NPI Number | 1801175799
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Entity Type | Individual
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Provider Name | LISA HAAS BACH M.A. L.L.P.
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Gender | Female
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Dates
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Enumeration Date | 08/09/2011
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Last Update Date | 08/09/2011
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Provider Practice Location Address
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Address Line | 725 S ADAMS RD SUITE 254
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6902
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Country | US
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Telephone | 248-346-3845
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Fax |
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Provider Business Mailing Address
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Address Line | 715 BAUMAN AVE
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City | ROYAL OAK
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State | MI
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Zip | 48073-2070
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Country | US
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Telephone | 248-346-3845
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301006457
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License Number State | MI
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