Provider Demographics
NPI:1699355800
Name:ALLISON, LISA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:ALLISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52466
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-0124
Mailing Address - Country:US
Mailing Address - Phone:808-633-3416
Mailing Address - Fax:
Practice Address - Street 1:5860 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9449
Practice Address - Country:US
Practice Address - Phone:928-402-0491
Practice Address - Fax:928-402-0490
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-191031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty