Healthcare Provider Details

I. General information

NPI: 1588711543
Provider Name (Legal Business Name): LISA ANN JOSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14340 TORREY CHASE BLVD SUITE 160
HOUSTON TX
77014-1021
US

IV. Provider business mailing address

14340 TORREY CHASE BLVD SUITE 160
HOUSTON TX
77014-1021
US

V. Phone/Fax

Practice location:
  • Phone: 281-580-8086
  • Fax: 281-580-7129
Mailing address:
  • Phone: 281-580-8086
  • Fax: 281-580-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberK5573
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: