Provider Demographics
NPI:1275729998
Name:LISANTI, LISA ANN (MS)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:LISANTI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W 38TH ST
Mailing Address - Street 2:SUITE 53
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6321
Mailing Address - Country:US
Mailing Address - Phone:512-377-2500
Mailing Address - Fax:512-377-2501
Practice Address - Street 1:1500 W 38TH ST
Practice Address - Street 2:SUITE 53
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6321
Practice Address - Country:US
Practice Address - Phone:512-377-2500
Practice Address - Fax:512-377-2501
Is Sole Proprietor?:No
Enumeration Date:2007-09-16
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX76460101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health