Provider Demographics
NPI:1477079564
Name:DRAPER, LISA MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:DRAPER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 S ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1763
Mailing Address - Country:US
Mailing Address - Phone:989-732-4357
Mailing Address - Fax:
Practice Address - Street 1:711 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1763
Practice Address - Country:US
Practice Address - Phone:989-732-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)