Provider Demographics
NPI:1225497415
Name:VANVLEET, LISA LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:LYNN
Last Name:VANVLEET
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20410 GENTLE MIST LN
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5767
Mailing Address - Country:US
Mailing Address - Phone:832-308-0467
Mailing Address - Fax:
Practice Address - Street 1:4119 MONTROSE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-4963
Practice Address - Country:US
Practice Address - Phone:832-308-0467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical