Provider Demographics
NPI:1629099627
Name:BREISCH, LISA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:BREISCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HARMONY CENTER FOR HOLISTIC PSYCHOTHERAPY
Mailing Address - Street 2:6625 N. 2ND STREET
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111
Mailing Address - Country:US
Mailing Address - Phone:815-639-0300
Mailing Address - Fax:815-639-0303
Practice Address - Street 1:HARMONY CENTER FOR HOLISTIC PSYCHOTHERAPY
Practice Address - Street 2:6625 N. 2ND STREET
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111
Practice Address - Country:US
Practice Address - Phone:815-639-0300
Practice Address - Fax:815-639-0303
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL180003465103TF0000X, 103TH0004X, 103T00000X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X
IL18003465103TP2701X, 103TF0000X, 101YM0800X, 101YP2500X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180-003465OtherILLINOIS STATE LICENSE