Provider Demographics
NPI:1154281335
Name:CALLIHAN DE VRIES, LISA S (LCC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:CALLIHAN DE VRIES
Suffix:
Gender:F
Credentials:LCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 CLIFFS DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-7332
Mailing Address - Country:US
Mailing Address - Phone:734-262-0817
Mailing Address - Fax:
Practice Address - Street 1:2301 S HURON PKWY STE 2B
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5133
Practice Address - Country:US
Practice Address - Phone:734-262-0817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451024722101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor