Healthcare Provider Details

I. General information

NPI: 1619681731
Provider Name (Legal Business Name): LISA MARIE OLMOS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARIE BENAVIDES

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5934 S STAPLES ST STE 206
CORPUS CHRISTI TX
78413-3842
US

IV. Provider business mailing address

4329 ELDORA DR
CORPUS CHRISTI TX
78413-4439
US

V. Phone/Fax

Practice location:
  • Phone: 361-314-6938
  • Fax:
Mailing address:
  • Phone: 361-793-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number77241
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: