Basic Information
| Provider Information | |||||||||
| NPI: | 1336474154 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEIF | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | DEBORAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6221 PHYSICIANS CT | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477154031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124917739 | ||||||||
| FaxNumber: | 8124913242 | ||||||||
| Practice Location | |||||||||
| Address1: | 6221 PHYSICIANS CT | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477154031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124917739 | ||||||||
| FaxNumber: | 8124913242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2009 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 87000465A | IN | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 34005793A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 300052189 | 05 | IN | MEDICAID |