Provider Demographics
NPI:1316194764
Name:JOY, LISA ANN (LLPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:JOY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9681
Mailing Address - Country:US
Mailing Address - Phone:989-362-8636
Mailing Address - Fax:989-362-7800
Practice Address - Street 1:42 N MOUNT TOM RD
Practice Address - Street 2:
Practice Address - City:MIO
Practice Address - State:MI
Practice Address - Zip Code:48647-8739
Practice Address - Country:US
Practice Address - Phone:989-826-3208
Practice Address - Fax:989-826-6779
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health