Provider Demographics
NPI:1528489549
Name:PIOSKE, LEE (LISAC)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:PIOSKE
Suffix:
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 E OCOTILLO RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-1150
Mailing Address - Country:US
Mailing Address - Phone:602-424-0373
Mailing Address - Fax:602-279-1316
Practice Address - Street 1:1845 E OCOTILLO RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-1150
Practice Address - Country:US
Practice Address - Phone:602-424-0373
Practice Address - Fax:602-279-1316
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 11674101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)