Provider Demographics
NPI:1013381276
Name:LISA J. SNOW, LCSW, LLC
Entity Type:Organization
Organization Name:LISA J. SNOW, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-975-4301
Mailing Address - Street 1:314 E PROMENADE ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2857
Mailing Address - Country:US
Mailing Address - Phone:573-975-4301
Mailing Address - Fax:573-975-4304
Practice Address - Street 1:314 E PROMENADE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2857
Practice Address - Country:US
Practice Address - Phone:573-975-4301
Practice Address - Fax:573-975-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130253641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty