Provider Demographics
NPI:1467643296
Name:KING, LISA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:KING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1733 HARRODSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3617
Mailing Address - Country:US
Mailing Address - Phone:859-296-6197
Mailing Address - Fax:859-296-0362
Practice Address - Street 1:1733 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3667
Practice Address - Country:US
Practice Address - Phone:859-276-5344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1351103TC0700X
KY1531103TC0700X
KY130232103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30612022Medicaid
KY7100303500Medicaid
KYK001872Medicaid
KY30612022Medicaid
KYK001872Medicare UPIN