Basic Information
| Provider Information | |||||||||
| NPI: | 1205284049 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LISA INOUE LMSW PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3443 BURBANK DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481051518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347071013 | ||||||||
| FaxNumber: | 7343451012 | ||||||||
| Practice Location | |||||||||
| Address1: | 2311 SHELBY AVE | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481033849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347071013 | ||||||||
| FaxNumber: | 7343451012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2016 | ||||||||
| LastUpdateDate: | 06/02/2016 | ||||||||
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| AuthorizedOfficialLastName: | INOUE | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PSYCHOTHERAPIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7349045977 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801081902 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.