MEDICARE: MRS. LISA SUE WHIPPLE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	S23830	TX

General Provider Information

NPI Number	:	1093820987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA SUE WHIPPLE LCSW

Provider Business Mailing Address
First Line	:	3507 DANCING DAISY LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-1750
Country	:	US
Telephone Number	:	281-730-9733
Fax Number	:

Provider Business Practice Location Address
First Line	:	2116 THOMPSON RD STE 102
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-5415
Country	:	US
Telephone Number	:	281-730-9733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	09/11/2022

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