Provider Demographics
NPI:1558876623
Name:MICHELIS, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MICHELIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-2929
Mailing Address - Country:US
Mailing Address - Phone:989-358-0673
Mailing Address - Fax:
Practice Address - Street 1:181 N BARLOW RD
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:MI
Practice Address - Zip Code:48740-9607
Practice Address - Country:US
Practice Address - Phone:989-736-8716
Practice Address - Fax:989-358-3776
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851100418104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker