Provider Demographics
NPI:1467221549
Name:JOHNSON HAIRE, LISA (DSW, MSW, LCSW)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:JOHNSON HAIRE
Suffix:
Gender:F
Credentials:DSW, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 MARYLAND AVE UNIT 11382
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-5510
Mailing Address - Country:US
Mailing Address - Phone:314-816-6129
Mailing Address - Fax:
Practice Address - Street 1:2268 LUXMORE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-4522
Practice Address - Country:US
Practice Address - Phone:314-816-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040266051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical