Healthcare Provider Details

I. General information

NPI: 1750652988
Provider Name (Legal Business Name): LISA RAE FRANCIS LCSW, L.I.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LISA RAE BURCH

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13157 SE 132ND AVE
HAPPY VALLEY OR
97086-8401
US

IV. Provider business mailing address

13203 SE 172ND AVE STE 166 MAIL BOX NUMBER: 313
HAPPY VALLEY OR
97086
US

V. Phone/Fax

Practice location:
  • Phone: 714-217-7189
  • Fax:
Mailing address:
  • Phone: 971-421-7718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60254612
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL13418
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: