Provider Demographics
NPI:1508364571
Name:HUSAMADEEN, LISA R (LPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:R
Last Name:HUSAMADEEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 TOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5140
Mailing Address - Country:US
Mailing Address - Phone:216-738-9248
Mailing Address - Fax:
Practice Address - Street 1:2121 S GREEN RD STE 213
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3338
Practice Address - Country:US
Practice Address - Phone:216-481-8585
Practice Address - Fax:216-459-7580
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional