MEDICARE: MARIA ELENA LISAC PHD

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	101Y00000X	Counselor	MH9671	FL
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1497995609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ELENA LISAC PHD

Provider Business Mailing Address
First Line	:	1223 WEST FOREST DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043
Country	:	US
Telephone Number	:	832-647-1908
Fax Number	:	281-589-8868

Provider Business Practice Location Address
First Line	:	1223 WEST FOREST DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043
Country	:	US
Telephone Number	:	832-647-1908
Fax Number	:	281-589-8868

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

Provider Enumeration Date	:	02/27/2009
Last Update Date	:	02/27/2009

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