Provider Demographics
NPI:1073661443
Name:OGREN, LISA ANN (MA LPC LBSW CRC CCFC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:OGREN
Suffix:
Gender:F
Credentials:MA LPC LBSW CRC CCFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N WEST AVE
Mailing Address - Street 2:SUITE #400
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202
Mailing Address - Country:US
Mailing Address - Phone:517-780-3336
Mailing Address - Fax:517-796-4561
Practice Address - Street 1:1218 GREENWOOD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201
Practice Address - Country:US
Practice Address - Phone:517-990-0596
Practice Address - Fax:577-990-1280
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002806 027890101Y00000X
102451 F19774101Y00000X
MI6802066319104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker