Provider Demographics
NPI:1710245006
Name:PEACOCK, LISA MARTINEZ (LCSW, LSCSW, LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARTINEZ
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:LCSW, LSCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 JOHNSON DR
Mailing Address - Street 2:SUITE 288
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2911
Mailing Address - Country:US
Mailing Address - Phone:913-522-9283
Mailing Address - Fax:913-353-9351
Practice Address - Street 1:7716 W 65TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-3830
Practice Address - Country:US
Practice Address - Phone:913-522-9283
Practice Address - Fax:913-353-9351
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS41381041C0700X
MO20-32446431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical