Provider Demographics
NPI:1174795918
Name:FELL, LISA BRINSON (AUD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:BRINSON
Last Name:FELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1261 W GREEN OAKS BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-8348
Mailing Address - Country:US
Mailing Address - Phone:817-451-4818
Mailing Address - Fax:817-451-4828
Practice Address - Street 1:1261 W GREEN OAKS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-8348
Practice Address - Country:US
Practice Address - Phone:817-451-4818
Practice Address - Fax:817-451-4828
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51301237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2045627Medicaid