Provider Demographics
NPI:1003118258
Name:REICH, LISA LAVERNE (MSHR, LPC, CM III)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:LAVERNE
Last Name:REICH
Suffix:
Gender:F
Credentials:MSHR, LPC, CM III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 E HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-3929
Mailing Address - Country:US
Mailing Address - Phone:918-916-7932
Mailing Address - Fax:
Practice Address - Street 1:507 E HARRISON AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-3929
Practice Address - Country:US
Practice Address - Phone:918-916-7932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-20
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200359380 AMedicaid