Provider Demographics
NPI:1265669261
Name:SHIFFLETT, LISA ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:SHIFFLETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 HOLSTON DR
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-3126
Mailing Address - Country:US
Mailing Address - Phone:423-787-8765
Mailing Address - Fax:423-787-8794
Practice Address - Street 1:404 HOLSTON DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-3126
Practice Address - Country:US
Practice Address - Phone:423-787-8765
Practice Address - Fax:423-787-8794
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2481101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional