Healthcare Provider Details

I. General information

NPI: 1447848957
Provider Name (Legal Business Name): LISA MCMASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2021
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8418 54TH CT SE
LACEY WA
98513-4659
US

IV. Provider business mailing address

8418 54TH CT SE
LACEY WA
98513-4659
US

V. Phone/Fax

Practice location:
  • Phone: 769-221-3463
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA.BA.70121283
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: