Healthcare Provider Details

I. General information

NPI: 1033354501
Provider Name (Legal Business Name): LISA D MCGRATH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 HIGHWAY N
O FALLON MO
63368-7013
US

IV. Provider business mailing address

7400 HIGHWAY N
O FALLON MO
63368-7013
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-7080
  • Fax:
Mailing address:
  • Phone: 636-561-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2001000880
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: