Provider Demographics
NPI:1730335647
Name:HATTAR, LYANA VICTORIA (LPC)
Entity type:Individual
Prefix:
First Name:LYANA
Middle Name:VICTORIA
Last Name:HATTAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LYANA
Other - Middle Name:I
Other - Last Name:SAFO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:33200 DEQUINDRE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5967
Mailing Address - Country:US
Mailing Address - Phone:586-354-1489
Mailing Address - Fax:586-803-4289
Practice Address - Street 1:33200 DEQUINDRE RD STE 100
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5967
Practice Address - Country:US
Practice Address - Phone:586-354-1489
Practice Address - Fax:586-803-4289
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008581101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1366905408Medicaid