Individual
LISA D PRINCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
9111 BROADWAY, SUITE Q, MERRILLVILLE, IN 46410
(219) 736-0003
(219) 756-2315
Mailing address
9111 BROADWAY, SUITE Q, MERRILLVILLE, IN 46410
(219) 736-0003
(219) 756-2315
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041869A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000373331
ANTHEM
IN
Enumeration date
08/24/2006
Last updated
01/17/2008
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