Doctor Name: | LISA AILEEN BAREISS-JAYHAN |
NPI Number: | 1255604476 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 149006542 |
Business Practice Address: | 1509 Turrell St North Port, FL - 342866186 |
Business Phone Number: | 9415268521 |
Business Fax Number: | |
Mailing Address: | 1509 Turrell St, NORTH PORT |
State: | FL |
Postal Code: | 342866186 |
Phone Number: | 9415268521 |
Fax Number: | |
NPI Enumeration Date: | 02/18/2012 |
NPI Last Update Date: | 02/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 149006542 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |