Healthcare Provider Details

I. General information

NPI: 1578041620
Provider Name (Legal Business Name): LISA MARIE LAGOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N ARGONNE RD STE 204
SPOKANE VALLEY WA
99212-2839
US

IV. Provider business mailing address

11116 E 44TH AVE
SPOKANE VALLEY WA
99206-9405
US

V. Phone/Fax

Practice location:
  • Phone: 208-699-2595
  • Fax:
Mailing address:
  • Phone: 620-797-0809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61135392
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: