Healthcare Provider Details

I. General information

NPI: 1548419716
Provider Name (Legal Business Name): LISA A POLO M.ED.,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 VALLEY VIEW RD
WALDRON AR
72958-5042
US

IV. Provider business mailing address

5400 VALLEY VIEW RD
WALDRON AR
72958-5042
US

V. Phone/Fax

Practice location:
  • Phone: 940-443-4039
  • Fax:
Mailing address:
  • Phone: 940-443-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17510
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2303009
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: