Provider Demographics
NPI:1255751590
Name:FRAZIER, LISA MARIE (LPC, LMFT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:RISELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:206 W IRONWOOD DR # 1012
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2640
Mailing Address - Country:US
Mailing Address - Phone:757-645-7722
Mailing Address - Fax:757-645-2808
Practice Address - Street 1:206 W IRONWOOD DR # 1012
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2640
Practice Address - Country:US
Practice Address - Phone:757-645-7722
Practice Address - Fax:757-645-2808
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-8346101YP2500X
IDLMFT-8348106H00000X
VA0717001312106H00000X
VA0701005793101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist