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Individual

LISA ROOT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PSYD

Contact information

Practice address
442 HAGELBARGER AVE, FAIRBANKS, AK 99712-1917
(907) 350-4353
Mailing address
442 HAGELBARGER AVE, FAIRBANKS, AK 99712-1917
(907) 350-4353

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
012375
CO

Other

Enumeration date
04/15/2013
Last updated
04/15/2013
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