| Doctor Name: | DR. LISA R BLACKMAN |
| NPI Number: | 1255323838 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | |
| Business Practice Address: | 314 Mdos/ Sgoh 1090 Arnold Drive Little Rock Afb, AR - 720990001 |
| Business Phone Number: | 5019877338 |
| Business Fax Number: | 5019878087 |
| Mailing Address: | 314 Mdos/ Sgoh, 1090 Arnold Drive LITTLE ROCK AFB |
| State: | AR |
| Postal Code: | 72099 |
| Phone Number: | 5019877338 |
| Fax Number: | 5019878087 |
| NPI Enumeration Date: | 08/18/2005 |
| NPI Last Update Date: | 09/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |