Lisa Renee Haston-Fuller, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

5101011198 Issued in MI

Practice address

9315 Telegraph Rd
Redford, MI 48239

Phone

(313) 450-4500

Fax

(313) 450-4514

NPI assigned

Sep 21, 2006

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

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• County of Macomb

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Clinton TWP, MI
  • NPI 1942532197
  Medicare reassignment NPD
• Neighborhood Service Organization

  • Community/Behavioral Health Agency
  • Detroit, MI
  • NPI 1891825808
  Medicare reassignment NPD
• County of Macomb

  • Public Health or Welfare Agency
  • Mount Clemens, MI
  • NPI 1760462253
  NPD
• Black Family Development, Inc.

  • Community/Behavioral Health Agency
  • Detroit, MI
  • NPI 1821120445
  NPD (past)
• Hegira Health, Inc.

  • Primary Care Clinic/Center
  • Westland, MI
  • NPI 1477141356
  NPD (past)
• Rd Senior Care Services PC

  • Gerontology Clinical Nurse Specialist
  • White Lake, MI
  • NPI 1336188101
  NPD (past)

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1831298397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 401259",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "482409259",
            "telephone_number": "248-557-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9315 TELEGRAPH RD",
            "city": "REDFORD",
            "state": "MI",
            "postal_code": "48239",
            "telephone_number": "313-450-4500",
            "fax_number": "313-450-4514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASTON-FULLER",
        "first_name": "LISA",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "5101011198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Hargrove, LLPC
• Kelly Harris
• Sierra Janae Harris
• Terkelia Harris
• William R Hart, PHD
• Paul Donald Hatton
• Dionna Hawk
• Tranika Jean Hawkins
• Steven Thomas Haynes, PROFESSIONAL COUNSEL
• Healing From the Rhythms Within Inc.

• Psychiatry Physician in Redford, MI
• Providers in Redford, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.