Provider Demographics
NPI:1518409291
Name:CHILDERS, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CHILDERS
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 1:1001 HARVARD WAY APT 114
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2001
Mailing Address - Country:US
Mailing Address - Phone:775-685-4538
Mailing Address - Fax:
Practice Address - Street 1:1001 HARVARD WAY APT 114
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2001
Practice Address - Country:US
Practice Address - Phone:775-685-4538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health