Healthcare Provider Details

I. General information

NPI: 1023261633
Provider Name (Legal Business Name): MISS LISA LANETTE PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S LOOP W #308
HOUSTON TX
77054-2653
US

IV. Provider business mailing address

2600 S LOOP W #308
HOUSTON TX
77054-2653
US

V. Phone/Fax

Practice location:
  • Phone: 713-667-2462
  • Fax:
Mailing address:
  • Phone: 713-667-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number64217
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: