Provider Demographics
NPI:1164507430
Name:MONGOVEN, LISA B (PSYD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:MONGOVEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 WINDMILL LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3929
Mailing Address - Country:US
Mailing Address - Phone:214-683-0848
Mailing Address - Fax:
Practice Address - Street 1:600 PARKER SQ
Practice Address - Street 2:SUITE 210
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7427
Practice Address - Country:US
Practice Address - Phone:214-683-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26897103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist