MEDICARE: MS. LISA STANTON PALLMEYER MA, LPC-S, LSSP

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	65257	TX
2	103TS0200X	School Psychologist	33446	TX

General Provider Information

NPI Number	:	1871852657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA STANTON PALLMEYER MA, LPC-S, LSSP

Provider Business Mailing Address
First Line	:	2409 EASTSIDE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-5603
Country	:	US
Telephone Number	:	512-940-6506
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 WESTBANK DR
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6623
Country	:	US
Telephone Number	:	512-904-0985
Fax Number	:

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

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	09/24/2015

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