Provider Demographics
NPI:1457487324
Name:LONGENBAUGH, LISA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:LONGENBAUGH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 HUDSON LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6035
Mailing Address - Country:US
Mailing Address - Phone:318-323-1505
Mailing Address - Fax:318-323-1361
Practice Address - Street 1:1103 HUDSON LN
Practice Address - Street 2:SUITE 1
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6035
Practice Address - Country:US
Practice Address - Phone:318-323-1505
Practice Address - Fax:318-323-1361
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health