Provider Demographics
NPI:1437203239
Name:EFFENDI, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:EFFENDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 E RAY RD STE A209
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8720
Mailing Address - Country:US
Mailing Address - Phone:480-654-0992
Mailing Address - Fax:480-245-4398
Practice Address - Street 1:1820 E RAY RD STE A209
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8720
Practice Address - Country:US
Practice Address - Phone:480-654-0992
Practice Address - Fax:480-245-4398
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
AZLPC 12499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ169725Medicaid