Provider Demographics
NPI:1568665982
Name:BELL, LISA S (MA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:BELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WEST THIRD ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-2320
Mailing Address - Country:US
Mailing Address - Phone:636-239-6787
Mailing Address - Fax:636-239-0626
Practice Address - Street 1:202 WEST THIRD ST.
Practice Address - Street 2:SUITE A
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-2320
Practice Address - Country:US
Practice Address - Phone:636-239-6787
Practice Address - Fax:636-239-0626
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01665103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist