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General NPI Number Information
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NPI Number | 1205667482
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Entity Type | Individual
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Provider Name | LISA ANN POLANCO LPC-A
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Gender | Female
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | PO BOX 690864
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City | SAN ANTONIO
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State | TX
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Zip | 78269-0864
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Country | US
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Telephone | 210-744-5863
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Fax | 210-479-1959
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Provider Business Mailing Address
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Address Line | 710 RIO CACTUS WAY
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City | SAN ANTONIO
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State | TX
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Zip | 78260-2615
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Country | US
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Telephone | 210-846-6163
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 95882
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License Number State | TX
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