Provider Demographics
NPI:1023347218
Name:FLORES, MARIA LISE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LISE
Last Name:FLORES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LISE
Other - Middle Name:
Other - Last Name:FLORES-REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3302 NE 91ST ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9517
Mailing Address - Country:US
Mailing Address - Phone:564-232-8225
Mailing Address - Fax:
Practice Address - Street 1:400 E EVERGREEN BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3263
Practice Address - Country:US
Practice Address - Phone:564-232-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4077103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
12068811OtherCAQH