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General NPI Number Information
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NPI Number | 1871637132
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Entity Type | Individual
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Provider Name | LISA J. H. FITZGIBBONS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 12/12/2018
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Provider Practice Location Address
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Address Line | 1003 BEAU TERRE DR SUITE 203
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City | BENTONVILLE
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State | AR
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Zip | 72712-6738
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Country | US
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Telephone | 479-271-8778
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Fax | 888-207-6093
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Provider Business Mailing Address
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Address Line | PO BOX 2449
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City | BENTONVILLE
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State | AR
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Zip | 72712-2449
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Country | US
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Telephone | 479-271-8778
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Fax | 888-207-6093
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 894
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 32121
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 07-19P
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License Number State | AR
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