Provider Demographics
NPI:1558676643
Name:SNOW, LISA M (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:SNOW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:21900 WILLAMETTE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3284
Mailing Address - Country:US
Mailing Address - Phone:503-653-0631
Mailing Address - Fax:503-653-1464
Practice Address - Street 1:21900 WILLAMETTE DR STE 202
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3284
Practice Address - Country:US
Practice Address - Phone:503-653-0631
Practice Address - Fax:503-653-1464
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR3137103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health