Provider Demographics
NPI:1295124972
Name:MICHEL, LISA MAIRE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MAIRE
Last Name:MICHEL
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 1:4710 BROOMTAIL CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-9305
Mailing Address - Country:US
Mailing Address - Phone:916-390-0242
Mailing Address - Fax:
Practice Address - Street 1:1401 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1024
Practice Address - Country:US
Practice Address - Phone:925-778-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA5439081OtherKAISER