Provider Demographics
NPI:1053506717
Name:TOBUREN, LISA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:S
Last Name:TOBUREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 POYNTZ AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6355
Mailing Address - Country:US
Mailing Address - Phone:785-320-7331
Mailing Address - Fax:
Practice Address - Street 1:720 POYNTZ AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6355
Practice Address - Country:US
Practice Address - Phone:785-320-7331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2333103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist