Provider Demographics
NPI:1376608414
Name:BALICK, LISA RENEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RENEE
Last Name:BALICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 BISSONNET
Mailing Address - Street 2:282
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2100
Mailing Address - Country:US
Mailing Address - Phone:713-666-1354
Mailing Address - Fax:713-666-9057
Practice Address - Street 1:3400 BISSONNET ST
Practice Address - Street 2:STE 282
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2100
Practice Address - Country:US
Practice Address - Phone:713-666-1354
Practice Address - Fax:713-666-9057
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22623103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00H20RMedicare UPIN
00H20RMedicare ID - Type Unspecified