Provider Demographics
NPI:1497357859
Name:CLARKE, LISA CONTRERAS (RD, CSSD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CONTRERAS
Last Name:CLARKE
Suffix:
Gender:F
Credentials:RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 HARVARD ST APT D
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-1644
Mailing Address - Country:US
Mailing Address - Phone:254-640-0612
Mailing Address - Fax:
Practice Address - Street 1:211 REDBIRD LANE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-9801
Practice Address - Country:US
Practice Address - Phone:409-880-2359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85055133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics