Provider Demographics
NPI:1508226648
Name:LANCASTER, LISHA
Entity Type:Individual
Prefix:
First Name:LISHA
Middle Name:
Last Name:LANCASTER
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:PO BOX 1271
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74355-1271
Mailing Address - Country:US
Mailing Address - Phone:918-675-4100
Mailing Address - Fax:918-675-4615
Practice Address - Street 1:304 N MICKEY MANTLE BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:OK
Practice Address - Zip Code:74339-1110
Practice Address - Country:US
Practice Address - Phone:918-253-6548
Practice Address - Fax:918-253-6548
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)