Basic Information
| Provider Information | |||||||||
| NPI: | 1104542695 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OORLOG | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | KRAFICK | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7663 E PALM LN | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852071306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803269049 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 N PRIEST DR | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852881213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8337190886 | ||||||||
| FaxNumber: | 7025894872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2022 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2799 | AZ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.