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General NPI Number Information
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NPI Number | 1528689593
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Entity Type | Individual
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Provider Name | DR. LISA NICOLE MCCLEARY
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Gender | Female
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Dates
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Enumeration Date | 04/30/2020
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 518 E HOSPITAL ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-5239
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Country | US
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Telephone | 936-462-5877
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Fax |
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Provider Business Mailing Address
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Address Line | 223 E CALIFORNIA ST
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City | NACOGDOCHES
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State | TX
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Zip | 75965-3567
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Country | US
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Telephone | 936-645-7048
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 70636
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 36982
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 4551
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License Number State | TX
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