Provider Demographics
NPI:1558634485
Name:RHEE, LISA (CP, BCBA-D)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RHEE
Suffix:
Gender:F
Credentials:CP, BCBA-D
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4700 IRVING BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4283
Mailing Address - Country:US
Mailing Address - Phone:505-569-7003
Mailing Address - Fax:866-278-1501
Practice Address - Street 1:4040 MCDERMOTT RD STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7735
Practice Address - Country:US
Practice Address - Phone:855-295-3276
Practice Address - Fax:888-588-2752
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-07-3856103K00000X
NMPSY-2023-0005103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst