Provider Demographics
NPI:1255604476
Name:BAREISS-JAYHAN, LISA AILEEN
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:AILEEN
Last Name:BAREISS-JAYHAN
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 1:1509 TURRELL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-6186
Mailing Address - Country:US
Mailing Address - Phone:941-526-8521
Mailing Address - Fax:
Practice Address - Street 1:1509 TURRELL ST
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-6186
Practice Address - Country:US
Practice Address - Phone:941-526-8521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-18
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149006542101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health