Organization Name: | LISA EVANS MA, INC. |
NPI Number: | 1164757290 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LISA CAROL EVANS (CEO) |
Mailing Address: | 808 S Ballard Ave Suite 100 Wylie |
State: | TX US |
Postal Code: | 750984224 |
Phone Number: | 9725228448 |
Fax Number: | 9724292164 |
NPI Enumeration Date: | 10/07/2009 |
NPI Last Update Date: | 01/02/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 65594 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |