Provider Demographics
NPI:1639241292
Name:BETZ, LISA JANEAN (LCSW, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JANEAN
Last Name:BETZ
Suffix:
Gender:F
Credentials:LCSW, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7124 N OZARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1066
Mailing Address - Country:US
Mailing Address - Phone:773-775-5437
Mailing Address - Fax:
Practice Address - Street 1:401 S CLINTON ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3800
Practice Address - Country:US
Practice Address - Phone:312-793-1372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0103181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical