Provider Demographics
NPI:1699825711
Name:MERRIN, LISA SOMMER (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:SOMMER
Last Name:MERRIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:MERRIN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6704 S TERRACE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4006
Mailing Address - Country:US
Mailing Address - Phone:480-215-0424
Mailing Address - Fax:
Practice Address - Street 1:500 W GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3599
Practice Address - Country:US
Practice Address - Phone:480-838-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3253103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ569858OtherAHCCCS PROVIDER NUMBER