Provider Demographics
NPI:1003906926
Name:LISA M LYALL PHD INC
Entity Type:Organization
Organization Name:LISA M LYALL PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LYALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:513-521-0500
Mailing Address - Street 1:8622 WINTON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4835
Mailing Address - Country:US
Mailing Address - Phone:513-521-0500
Mailing Address - Fax:513-521-5010
Practice Address - Street 1:8622 WINTON RD
Practice Address - Street 2:SUITE C
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4835
Practice Address - Country:US
Practice Address - Phone:513-521-0500
Practice Address - Fax:513-521-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5203103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty