Healthcare Provider Details

I. General information

NPI: 1295278745
Provider Name (Legal Business Name): CHRISTI LISENBY-HART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10473 OLD HAMMOND HWY
BATON ROUGE LA
70816-8264
US

IV. Provider business mailing address

10473 OLD HAMMOND HWY
BATON ROUGE LA
70816-8264
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-1910
  • Fax:
Mailing address:
  • Phone: 225-924-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7373
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: