Provider Demographics
NPI:1609083575
Name:KEYSER, LISA BELINDA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BELINDA
Last Name:KEYSER
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 1:8279 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48204-3217
Mailing Address - Country:US
Mailing Address - Phone:313-318-7438
Mailing Address - Fax:
Practice Address - Street 1:9851 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1424
Practice Address - Country:US
Practice Address - Phone:313-883-8327
Practice Address - Fax:313-883-3957
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor