Healthcare Provider Details

I. General information

NPI: 1033977251
Provider Name (Legal Business Name): LISA TRELEAVEN EDD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16915 WALDEN RD # 311
MONTGOMERY TX
77356-3219
US

IV. Provider business mailing address

16915 WALDEN RD # 311
MONTGOMERY TX
77356-3219
US

V. Phone/Fax

Practice location:
  • Phone: 832-422-6036
  • Fax:
Mailing address:
  • Phone: 832-422-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number66262
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: