Provider Demographics
NPI:1346613296
Name:GALLIANO, LISA TRAVIS (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:TRAVIS
Last Name:GALLIANO
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 1:1221 ABRAMS RD
Mailing Address - Street 2:#325
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5578
Mailing Address - Country:US
Mailing Address - Phone:972-559-4281
Mailing Address - Fax:
Practice Address - Street 1:1221 ABRAMS RD
Practice Address - Street 2:#325
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5578
Practice Address - Country:US
Practice Address - Phone:972-559-4281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-01
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional