Basic Information
| Provider Information | |||||||||
| NPI: | 1083107650 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNELL | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | QMHSMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 434 EASTLAND RD | ||||||||
| Address2: | |||||||||
| City: | BEREA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440171217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402608327 | ||||||||
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| Practice Location | |||||||||
| Address1: | 195 N GRANT AVE STE 250 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432152855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402342006 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2018 | ||||||||
| LastUpdateDate: | 06/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 171M00000X | OH | N | Other Service Providers | Case Manager/Care Coordinator | 174200000X | N | Other Service Providers | Meals | 174400000X | N | Other Service Providers | Specialist | 175T00000X | N | 193200000X MULTI-SPECIALTY GROUP | 251E00000X | N | Agencies | Home Health | 251S00000X | N | Agencies | Community/Behavioral Health | 253Z00000X | N | Agencies | In Home Supportive Care | 347C00000X | N | Transportation Services | Private Vehicle | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.