MEDICARE: LISA LANE DAVISSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	15989	TX

General Provider Information

NPI Number	:	1023237658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA LANE DAVISSON LPC

Provider Business Mailing Address
First Line	:	17725 WINDFLOWER WAY UNIT 103
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5206
Country	:	US
Telephone Number	:	214-808-4670
Fax Number	:	214-279-5198

Provider Business Practice Location Address
First Line	:	8105 RASOR BLVD STE 117
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-0118
Country	:	US
Telephone Number	:	214-267-8673
Fax Number	:	214-279-5198

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	02/07/2024

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