Provider Demographics
NPI:1649541590
Name:LOZANO, YANEISHA GRAHAM
Entity type:Individual
Prefix:MRS
First Name:YANEISHA
Middle Name:GRAHAM
Last Name:LOZANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YANEISHA
Other - Middle Name:
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2842 45TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2986
Mailing Address - Country:US
Mailing Address - Phone:219-228-8799
Mailing Address - Fax:815-725-1284
Practice Address - Street 1:2842 45TH ST STE A
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2986
Practice Address - Country:US
Practice Address - Phone:219-228-8799
Practice Address - Fax:815-725-1284
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002289A101YM0800X
TX85477101YM0800X
IL180.008040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health