Provider Demographics
NPI:1487492104
Name:BUENDICHO, LISA LARAE (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LARAE
Last Name:BUENDICHO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LARAE
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2938 BLENHEIM PARK
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-2389
Mailing Address - Country:US
Mailing Address - Phone:210-317-6405
Mailing Address - Fax:
Practice Address - Street 1:2938 BLENHEIM PARK
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-2389
Practice Address - Country:US
Practice Address - Phone:210-317-6405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73864101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health