Provider Demographics
NPI:1659750396
Name:SIPES, LISA (MS, MA, LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SIPES
Suffix:
Gender:F
Credentials:MS, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10673 BRADLEY CIR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-7680
Mailing Address - Country:US
Mailing Address - Phone:214-734-3477
Mailing Address - Fax:
Practice Address - Street 1:9550 FOREST LN
Practice Address - Street 2:BUILDING 1, SUITE 116
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5905
Practice Address - Country:US
Practice Address - Phone:214-734-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional