Provider Demographics
NPI:1225500465
Name:FEEZLE, LISA (BCBA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FEEZLE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:NESTASIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1051 TIFFANY S
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1977
Mailing Address - Country:US
Mailing Address - Phone:855-629-6277
Mailing Address - Fax:
Practice Address - Street 1:1051 TIFFANY S
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1977
Practice Address - Country:US
Practice Address - Phone:855-629-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst