Basic Information
| Provider Information | |||||||||
| NPI: | 1093142317 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISBELL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | GARY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4572 S HAGADORN RD | ||||||||
| Address2: | STE 1C | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174812133 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4572 S HAGADORN RD | ||||||||
| Address2: | STE 1C | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174812133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2013 | ||||||||
| LastUpdateDate: | 09/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801095773 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.