1235582412 NPI number — MRS. LISA MARIE FOSTER LPCC

Table of content: MRS. LISA MARIE FOSTER LPCC (NPI 1235582412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235582412 NPI number — MRS. LISA MARIE FOSTER LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSTER
Provider First Name:
LISA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUBLIN
Provider Other First Name:
LISA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235582412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
427 W DUSSEL DR
Provider Second Line Business Mailing Address:
#205
Provider Business Mailing Address City Name:
MAUMEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43537-4208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1446 REYNOLDS RD
Provider Second Line Business Practice Location Address:
SUITE #313
Provider Business Practice Location Address City Name:
MAUMEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43537-1684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-720-5800
Provider Business Practice Location Address Fax Number:
419-720-4444
Provider Enumeration Date:
07/22/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  E.1300244 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)