Lisa Marie McIlvenna, DMIN

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401010105 Issued in MI

Practice address

315 W Larkin St
Midland, MI 48640

Phone

(989) 835-7511

Fax

(898) 357-5112

NPI assigned

Jun 1, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fresh Aire Samaritan Counseling Center

  • Community/Behavioral Health Agency
  • Midland, MI
  • NPI 1235491556
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610928000000",
    "number": "1043412240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 HOUGHTEN DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480982942",
            "telephone_number": "248-879-3220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 W LARKIN ST",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "48640",
            "telephone_number": "989-835-7511",
            "fax_number": "898-357-5112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCILVENNA",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DMIN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-01",
        "last_updated": "2021-01-18",
        "certification_date": "2021-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401010105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Nicole McGuire, LPC
• Laura Anne-Hall McGuire, P.T.
• Thomas Richard McGuirk, MSN, APRN, FNP-C
• Karen D McHenry, PA
• Michael P McHenry, PA
• Mark Kristofer McIntire, PA
• Nolan McIntosh, PT, DPT, ATC
• McLaren Dental Associates, P.C.
• McLaren Health Management Group
• Charles Ian McLaren, DDS, MS

• Professional Counselor in Midland, MI
• Providers in Midland, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.