Provider Demographics
NPI:1033826342
Name:WITTPENN, LISA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:WITTPENN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3748 US HIGHWAY 59 N
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-8981
Mailing Address - Country:US
Mailing Address - Phone:936-259-2119
Mailing Address - Fax:936-286-3106
Practice Address - Street 1:3748 US HIGHWAY 59 N # A
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8981
Practice Address - Country:US
Practice Address - Phone:936-259-2119
Practice Address - Fax:936-286-3106
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health