Provider Demographics
NPI:1023261633
Name:PRICE, LISA LANETTE
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:LANETTE
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S LOOP W
Mailing Address - Street 2:#308
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2653
Mailing Address - Country:US
Mailing Address - Phone:713-667-2462
Mailing Address - Fax:
Practice Address - Street 1:2600 S LOOP W
Practice Address - Street 2:#308
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2653
Practice Address - Country:US
Practice Address - Phone:713-667-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64217101YP2500X
TX101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool