Healthcare Provider Details

I. General information

NPI: 1982916680
Provider Name (Legal Business Name): LISA LYNN HOUSTON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W COLLEGE AVE SUITE 19
SILVER CITY NM
88061-5002
US

IV. Provider business mailing address

PO BOX 1641
SILVER CITY NM
88062-1641
US

V. Phone/Fax

Practice location:
  • Phone: 575-574-0267
  • Fax: 575-388-1035
Mailing address:
  • Phone: 575-574-0267
  • Fax: 575-388-1035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1210
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0083931
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0083931
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0083931
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: