Healthcare Provider Details

I. General information

NPI: 1932420460
Provider Name (Legal Business Name): LISA KAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA KAN

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 EAST RD
HOUSTON TX
77054-6010
US

IV. Provider business mailing address

1215 LEE ST BOX 800203
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 936-978-0845
  • Fax:
Mailing address:
  • Phone: 434-924-2718
  • Fax: 434-243-6546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: