MEDICARE: LISA MICHAELS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1154461887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MICHAELS

Provider Business Mailing Address
First Line	:	3425 KENYON ST STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 KENYON ST STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5013
Country	:	US
Telephone Number	:	619-224-4642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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Directions to “ LISA MICHAELS ” Practice Location

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