Provider Demographics
NPI:1710910963
Name:HESS, LISA SUZANNE (MA, LMHC, CMHS, MHP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:SUZANNE
Last Name:HESS
Suffix:
Gender:F
Credentials:MA, LMHC, CMHS, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 S 20TH ST
Mailing Address - Street 2:#4
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4672
Mailing Address - Country:US
Mailing Address - Phone:360-424-6374
Mailing Address - Fax:
Practice Address - Street 1:4526 FEDERAL AVE
Practice Address - Street 2:MS-10
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2132
Practice Address - Country:US
Practice Address - Phone:425-349-8300
Practice Address - Fax:425-349-8304
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH000097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health