| Doctor Name: | LISA CLUGSTON |
| NPI Number: | 1073706768 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPCC |
| License Number: | 0142491 |
| Business Practice Address: | 4686 Corrales Rd Ste 4e Corrales, NM - 870488658 |
| Business Phone Number: | 5052386420 |
| Business Fax Number: | |
| Mailing Address: | 66 Griego Ct, CORRALES |
| State: | NM |
| Postal Code: | 870486500 |
| Phone Number: | 5052386420 |
| Fax Number: | |
| NPI Enumeration Date: | 08/25/2007 |
| NPI Last Update Date: | 03/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 0142491 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |