Provider Demographics
NPI:1366733867
Name:GRUBBS, LISA (LPC-INTERN, NCC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:LPC-INTERN, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 KAMLA RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-7450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 N GREENVILLE AVE
Practice Address - Street 2:STE 700
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-6707
Practice Address - Country:US
Practice Address - Phone:942-231-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66773101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health