Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 6401013883 | |
N | 101YS0200X | School Counselor | 6401013883 | MI |
NPI | 1245650142 |
---|---|
Provider Name | Lisa Drake Kruzel |
First Address | Boyne City, MI 49712-1310 |
Second Address | Boyne City, MI 49712-1310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2014 |
Last Update Date | 15/04/2020 |