Healthcare Provider Details

I. General information

NPI: 1740626324
Provider Name (Legal Business Name): LISA JOY HALE LPC-S LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8104 SPRING CYPRESS RD
SPRING TX
77379-3123
US

IV. Provider business mailing address

8104 SPRING CYPRESS RD
SPRING TX
77379-3123
US

V. Phone/Fax

Practice location:
  • Phone: 281-205-8786
  • Fax: 832-559-1939
Mailing address:
  • Phone: 281-205-8786
  • Fax: 832-559-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11687
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number68270
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: