Provider Demographics
NPI:1275580433
Name:ROLL, LISA (MS, ADTR LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ROLL
Suffix:
Gender:F
Credentials:MS, ADTR LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-5938
Mailing Address - Country:US
Mailing Address - Phone:918-337-9385
Mailing Address - Fax:918-331-9717
Practice Address - Street 1:245 S MADISON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2822
Practice Address - Country:US
Practice Address - Phone:918-336-1463
Practice Address - Fax:918-331-9717
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional