Provider Demographics
NPI:1215725320
Name:LIRA, PHILLIP G
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:G
Last Name:LIRA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 LOUISA ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-5200
Mailing Address - Country:US
Mailing Address - Phone:313-497-2665
Mailing Address - Fax:
Practice Address - Street 1:835 LOUISA ST STE 205
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-5200
Practice Address - Country:US
Practice Address - Phone:313-556-4359
Practice Address - Fax:313-583-7002
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician