Provider Demographics
NPI:1174620744
Name:DOCKTER, LISA MARIE (MS, LCPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:DOCKTER
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 E MARY ST
Mailing Address - Street 2:10
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-7602
Mailing Address - Country:US
Mailing Address - Phone:620-276-1500
Mailing Address - Fax:620-276-1548
Practice Address - Street 1:1807 E MARY ST
Practice Address - Street 2:10
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-7602
Practice Address - Country:US
Practice Address - Phone:620-276-1500
Practice Address - Fax:620-276-1548
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCPC 356101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional