MEDICARE: LISA RENEE WILSON MCCAUL

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	106H00000X	Marriage & Family Therapist		WA

General Provider Information

NPI Number	:	1790634756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA RENEE WILSON MCCAUL

Provider Business Mailing Address
First Line	:	12012 EVANSTON AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98133-8227
Country	:	US
Telephone Number	:	206-310-8115
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N 36TH ST STE 304
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8698
Country	:	US
Telephone Number	:	206-310-8115
Fax Number	:

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

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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