Provider Demographics
NPI:1275970675
Name:CECIL, LISA (LPE I)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CECIL
Suffix:
Gender:F
Credentials:LPE I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 ISAACS ORCHARD RD STE 207
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6799
Mailing Address - Country:US
Mailing Address - Phone:479-326-3335
Mailing Address - Fax:
Practice Address - Street 1:6801 ISAACS ORCHARD RD STE 207
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6799
Practice Address - Country:US
Practice Address - Phone:479-326-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR97-07EI103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist