Healthcare Provider Details

I. General information

NPI: 1720139769
Provider Name (Legal Business Name): LISA BLACKWOOD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425A BURNET RD
AUSTIN TX
78756-1627
US

IV. Provider business mailing address

7929 SNOOK HOOK TRL
AUSTIN TX
78729-4924
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-7337
  • Fax: 512-451-8729
Mailing address:
  • Phone: 512-451-7337
  • Fax: 512-451-8729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4065
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19803
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: