Provider Demographics
NPI:1750838173
Name:EILAND, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:EILAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:EILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:9894 BISSONNET ST STE 330
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8241
Mailing Address - Country:US
Mailing Address - Phone:708-275-6389
Mailing Address - Fax:
Practice Address - Street 1:9894 BISSONNET ST STE 330
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8241
Practice Address - Country:US
Practice Address - Phone:713-497-5344
Practice Address - Fax:713-513-5439
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
104100000X
IL149.0215791041C0700X
TX1043011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1427648641Medicaid