Healthcare Provider Details

I. General information

NPI: 1205627767
Provider Name (Legal Business Name): LISA-MARIE MAC LEAN LMFT-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E HUNTLAND DR STE 320
AUSTIN TX
78752-3741
US

IV. Provider business mailing address

14013 ROUNTREE RANCH LN
AUSTIN TX
78717-4826
US

V. Phone/Fax

Practice location:
  • Phone: 512-201-4501
  • Fax:
Mailing address:
  • Phone: 512-920-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number205848
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: