MEDICARE: LISA AILEEN BAREISS-JAYHAN

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	101YM0800X	Mental Health Counselor	149006542	IL

General Provider Information

NPI Number	:	1255604476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA AILEEN BAREISS-JAYHAN

Provider Business Mailing Address
First Line	:	1509 TURRELL ST
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-6186
Country	:	US
Telephone Number	:	941-526-8521
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 TURRELL ST
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-6186
Country	:	US
Telephone Number	:	941-526-8521
Fax Number	:

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

Provider Enumeration Date	:	02/18/2012
Last Update Date	:	02/18/2012

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