Provider Demographics
NPI:1659848752
Name:DR. LYZ, LLC
Entity Type:Organization
Organization Name:DR. LYZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBOER KREIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-365-5042
Mailing Address - Street 1:15 E. WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2708
Mailing Address - Country:US
Mailing Address - Phone:610-365-5042
Mailing Address - Fax:610-365-5044
Practice Address - Street 1:15 E. WALNUT ST.
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2708
Practice Address - Country:US
Practice Address - Phone:610-365-5042
Practice Address - Fax:610-365-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS017673OtherSTATE BOARD OF PSYCHOLOGY