MEDICARE: LISA MCVANN LPCC

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	101YP2500X	Professional Counselor	0165161	NM

General Provider Information

NPI Number	:	1588075493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MCVANN LPCC

Provider Business Mailing Address
First Line	:	715 E IDAHO AVE
Second Line	:	SUITE 2-E
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-4703
Country	:	US
Telephone Number	:	575-556-9585
Fax Number	:	575-556-9456

Provider Business Practice Location Address
First Line	:	715 E IDAHO AVE
Second Line	:	SUITE 2-E
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-4703
Country	:	US
Telephone Number	:	575-556-9585
Fax Number	:	575-556-9456

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

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	05/13/2014

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Directions to “ LISA MCVANN LPCC” Practice Location

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