Provider Demographics
NPI:1225485675
Name:BURRESS, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BURRESS
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 1:2326 WHEATON WAY STE 130B
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4344
Mailing Address - Country:US
Mailing Address - Phone:360-362-0048
Mailing Address - Fax:360-525-1032
Practice Address - Street 1:2326 WHEATON WAY STE 130B
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4344
Practice Address - Country:US
Practice Address - Phone:360-362-0048
Practice Address - Fax:360-525-1032
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW609754971041C0700X
WASC606647841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical