Provider Demographics
NPI:1093152886
Name:WORDEN, LISA A
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:WORDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 S TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1532
Mailing Address - Country:US
Mailing Address - Phone:641-210-7708
Mailing Address - Fax:
Practice Address - Street 1:687 S TAFT AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1532
Practice Address - Country:US
Practice Address - Phone:641-210-7708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health