Provider Demographics
NPI:1053630145
Name:SLAUGHTER, LISA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-4608
Mailing Address - Country:US
Mailing Address - Phone:214-729-7268
Mailing Address - Fax:972-216-1535
Practice Address - Street 1:221 E DAVIS ST
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-4608
Practice Address - Country:US
Practice Address - Phone:214-729-7268
Practice Address - Fax:972-216-1535
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63155101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional