| Lisa Lasala, Phd, Pc | |
|
999 Haynes St Ste 300 Birmingham MI 48009-6775 | |
| (248) 207-1863 | |
| Not Available |
| Full Name | Lisa Lasala, Phd, Pc |
|---|---|
| Speciality | Social Worker |
| Location | 999 Haynes St Ste 300, Birmingham, Michigan |
| Authorized Official Name and Position | Lisa Lasala (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2482071863 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Lasala, Phd, Pc 999 Haynes St Ste 300 Birmingham MI 48009-6775 Ph: (248) 207-1863 | Lisa Lasala, Phd, Pc 999 Haynes St Ste 300 Birmingham MI 48009-6775 Ph: (248) 207-1863 |
| NPI Number | 1306320064 |
|---|---|
| Provider Enumeration Date | 09/19/2018 |
| Last Update Date | 01/20/2022 |
| Certification Date | 01/20/2022 |
| Medicare PECOS PAC ID | 4880947001 |
|---|---|
| Medicare Enrollment ID | O20181105001748 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306320064 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Lisa G Lasala |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982687372 PECOS PAC ID: 6800040130 Enrollment ID: I20130213000498 |
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