Provider Demographics
NPI:1225263296
Name:SEIDEL, LISA SCHUBA (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:SCHUBA
Last Name:SEIDEL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:CHRISTINE
Other - Last Name:SCHUBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3616 SOPE CREEK FARM SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5174
Mailing Address - Country:US
Mailing Address - Phone:248-320-1343
Mailing Address - Fax:
Practice Address - Street 1:6637 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1675
Practice Address - Country:US
Practice Address - Phone:248-666-8870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011281101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor