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General NPI Number Information
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NPI Number | 1043451131
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Entity Type | Individual
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Provider Name | LISA MIKHAIL LISW-S, LICDC
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Gender | Female
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | DYESS AIR FORCE BASE 317 MAINTENANCE SQ
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City | DYESS AFB
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State | TX
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Zip | 79607
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Country | US
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Telephone | 915-979-5985
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Fax |
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Provider Business Mailing Address
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Address Line | 3125 PAUL ST
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City | ABILENE
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State | TX
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Zip | 79606-1185
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Country | US
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Telephone | 915-979-5985
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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