Provider Demographics
NPI:1225807761
Name:WOOLDRIDGE, LISA (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18010 FM 1488 RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-8562
Mailing Address - Country:US
Mailing Address - Phone:346-588-0045
Mailing Address - Fax:
Practice Address - Street 1:3500 W DAVIS ST STE 250
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1811
Practice Address - Country:US
Practice Address - Phone:346-588-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional