Provider Demographics
NPI:1992034326
Name:PEETZ, LISA MICHELLE (MA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:PEETZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10945 NW RAINMONT RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-4830
Mailing Address - Country:US
Mailing Address - Phone:503-646-4387
Mailing Address - Fax:503-629-8517
Practice Address - Street 1:10945 NW RAINMONT RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-4830
Practice Address - Country:US
Practice Address - Phone:503-646-4387
Practice Address - Fax:503-629-8517
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health