Provider Demographics
NPI:1114186939
Name:SPANN, LISA K (MED, CRC, LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:SPANN
Suffix:
Gender:F
Credentials:MED, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-3224
Mailing Address - Country:US
Mailing Address - Phone:318-323-7361
Mailing Address - Fax:318-325-0103
Practice Address - Street 1:600 WOOD ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-3224
Practice Address - Country:US
Practice Address - Phone:318-323-7361
Practice Address - Fax:318-325-0103
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2904101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor