Provider Demographics
NPI:1942307566
Name:FRANSEEN, LISA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:FRANSEEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 RACQUET CLUB DR
Mailing Address - Street 2:STE G
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4797
Mailing Address - Country:US
Mailing Address - Phone:231-409-0136
Mailing Address - Fax:231-933-4032
Practice Address - Street 1:3180 RACQUET CLUB DR
Practice Address - Street 2:STE G
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4797
Practice Address - Country:US
Practice Address - Phone:231-409-0136
Practice Address - Fax:231-933-4032
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012824103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2545OtherMEDICARE PTAN
MI68-0-B8-1360-0OtherBLUE CROSS IDENTIFICATION NUMBER