Provider Demographics
NPI:1508627472
Name:LISA BLOSSER, MA,
Entity Type:Organization
Organization Name:LISA BLOSSER, MA,
Other - Org Name:LISA BLOSSER, PLLC, PSYCHOTHERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-685-7652
Mailing Address - Street 1:7000 HAMPTON CTR STE H
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1762
Mailing Address - Country:US
Mailing Address - Phone:304-440-6810
Mailing Address - Fax:
Practice Address - Street 1:7000 HAMPTON CTR STE H
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1762
Practice Address - Country:US
Practice Address - Phone:304-440-6810
Practice Address - Fax:617-865-7064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)