Healthcare Provider Details

I. General information

NPI: 1457638975
Provider Name (Legal Business Name): LISA R CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 W 31ST ST
LAWRENCE KS
66047-3042
US

IV. Provider business mailing address

3015 W 31ST ST
LAWRENCE KS
66047-3042
US

V. Phone/Fax

Practice location:
  • Phone: 785-843-9262
  • Fax: 785-843-9264
Mailing address:
  • Phone: 785-843-9262
  • Fax: 785-843-9264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number118
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number759
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: