Provider Demographics
NPI:1003978065
Name:BRIZ, LISA CATHLEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CATHLEEN
Last Name:BRIZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3394 MCKELVEY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2531
Mailing Address - Country:US
Mailing Address - Phone:314-209-0900
Mailing Address - Fax:314-209-0912
Practice Address - Street 1:3394 MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2531
Practice Address - Country:US
Practice Address - Phone:314-209-0900
Practice Address - Fax:314-209-0912
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030265881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO184336OtherBLUE CROSS BLUE SHIELD