Provider Demographics
NPI:1457638975
Name:CARTER, LISA R
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3042
Mailing Address - Country:US
Mailing Address - Phone:785-843-9262
Mailing Address - Fax:785-843-9264
Practice Address - Street 1:3015 W 31ST ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-3042
Practice Address - Country:US
Practice Address - Phone:785-843-9262
Practice Address - Fax:785-843-9264
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS759101YM0800X
KS118101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)