MEDICARE: MS. LISA LYNN VANVLEET 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	25424	TX

General Provider Information

NPI Number	:	1225497415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA LYNN VANVLEET LCSW

Provider Business Mailing Address
First Line	:	20410 GENTLE MIST LN
Second Line	:	SECOND FLOOR
City	:	CYPRESS
State	:	TX
Zip	:	77433-5767
Country	:	US
Telephone Number	:	832-308-0467
Fax Number	:

Provider Business Practice Location Address
First Line	:	4119 MONTROSE BLVD
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77006-4963
Country	:	US
Telephone Number	:	832-308-0467
Fax Number	:

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

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	04/16/2017

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