Doctor Name: | LISA A DAVISSON |
NPI Number: | 1588096192 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | CO60214519 |
Business Practice Address: | 1390 Jesica Dr Selah, WA - 989421728 |
Business Phone Number: | 5096979891 |
Business Fax Number: | |
Mailing Address: | 1390 Jesica Dr, SELAH |
State: | WA |
Postal Code: | 989421728 |
Phone Number: | 5096979891 |
Fax Number: | |
NPI Enumeration Date: | 08/06/2013 |
NPI Last Update Date: | 03/28/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | CO60214519 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |