Provider Demographics
NPI:1639216948
Name:LISTER, RENEE (LPC)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:LISTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:FARLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2340 HUNTERS RUN DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-4154
Mailing Address - Country:US
Mailing Address - Phone:214-417-8706
Mailing Address - Fax:972-224-2429
Practice Address - Street 1:423 W WHEATLAND RD STE 101
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4630
Practice Address - Country:US
Practice Address - Phone:214-417-8706
Practice Address - Fax:972-224-2429
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58266101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185581902Medicaid