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General NPI Number Information
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NPI Number | 1780647859
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Entity Type | Organization
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Legal Business Name | LISA ESTELLE PSYD
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8606 N WALL STE 102
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City | SPOKANE
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State | WA
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Zip | 99218
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Country | US
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Telephone | 509-467-9111
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Fax | 509-468-1294
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Provider Business Mailing Address
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Address Line | 12605 N FAIRWOOD LN
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City | SPOKANE
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State | WA
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Zip | 99208
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Country | US
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Telephone | 509-467-9111
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Fax | 509-468-1294
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | LISA ESTELLE
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Credential | PSYD
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Telephone | 509-467-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY00002919
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License Number State | WA
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