Provider Demographics
NPI:1417279233
Name:LISA B. PARTYKA, PH.D. LLC
Entity Type:Organization
Organization Name:LISA B. PARTYKA, PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARTYKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:575-647-8040
Mailing Address - Street 1:2145 EL PASEO RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-6008
Mailing Address - Country:US
Mailing Address - Phone:575-647-8040
Mailing Address - Fax:
Practice Address - Street 1:4314 TEWA CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4348
Practice Address - Country:US
Practice Address - Phone:575-647-8040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03176603000261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center