Provider Demographics
NPI:1790429835
Name:NEELY, LISA M
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:NEELY
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 1:2023 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1349
Mailing Address - Country:US
Mailing Address - Phone:740-792-4011
Mailing Address - Fax:
Practice Address - Street 1:2023 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1349
Practice Address - Country:US
Practice Address - Phone:740-792-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator