Provider Demographics
NPI:1619681731
Name:OLMOS, LISA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:OLMOS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:BENAVIDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4901 SARATOGA BLVD APT 332
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2267
Mailing Address - Country:US
Mailing Address - Phone:361-793-3561
Mailing Address - Fax:
Practice Address - Street 1:5934 S STAPLES ST STE 206
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3842
Practice Address - Country:US
Practice Address - Phone:361-752-1589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional