Provider Demographics
NPI:1497152995
Name:MAZNIO, LISA (LPC, CCM, QMHP, BCC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MAZNIO
Suffix:
Gender:F
Credentials:LPC, CCM, QMHP, BCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N MARTEL AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4276
Mailing Address - Country:US
Mailing Address - Phone:248-495-1159
Mailing Address - Fax:
Practice Address - Street 1:1400 N MARTEL AVE APT 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046
Practice Address - Country:US
Practice Address - Phone:248-495-1159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional