Provider Demographics
NPI:1225194376
Name:ROARK, LISA MERZ (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MERZ
Last Name:ROARK
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-7004
Mailing Address - Country:US
Mailing Address - Phone:830-876-0222
Mailing Address - Fax:830-876-0275
Practice Address - Street 1:411 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:CARRIZO SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78834-3208
Practice Address - Country:US
Practice Address - Phone:830-876-0222
Practice Address - Fax:830-876-0275
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59536101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional