Provider Demographics
NPI:1003922501
Name:INOUE, LISA (MSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:INOUE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9520
Mailing Address - Country:US
Mailing Address - Phone:734-996-9111
Mailing Address - Fax:734-996-1950
Practice Address - Street 1:5340 PLYMOUTH RD STE 210
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9559
Practice Address - Country:US
Practice Address - Phone:734-707-1013
Practice Address - Fax:734-345-1012
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010819021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0963791OtherBCBS PIN