Provider Demographics
NPI:1558570705
Name:HALE, LISA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:HALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10555 MARTY ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-2555
Mailing Address - Country:US
Mailing Address - Phone:913-649-8820
Mailing Address - Fax:913-649-8823
Practice Address - Street 1:10555 MARTY ST
Practice Address - Street 2:STE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-2555
Practice Address - Country:US
Practice Address - Phone:913-649-8820
Practice Address - Fax:913-649-8823
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1296103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral