Basic Information
| Provider Information | |||||||||
| NPI: | 1225263296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHUBA | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.A., L.L.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2152 CASS BLVD | ||||||||
| Address2: | |||||||||
| City: | BERKLEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480721946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483201343 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6637 HIGHLAND RD | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483271675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486668870 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2009 | ||||||||
| LastUpdateDate: | 05/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401011281 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.